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Acute and Post-Acute COVID-19 Cardiovascular Complications: A Comprehensive Review
Christo Kole1, Εleni Stefanou2, Nikolaos Karvelas3
1Cardiology Department, Sismanoglio General Hospital of Attica, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece. christo.kole@gmail.com.
Insights
COVID-19 (coronavirus disease 2019) significantly increases cardiovascular risks, including heart failure and arrhythmias, for up to six months post-infection. Management strategies and risk factor identification are crucial for improving outcomes in affected patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- SARS-CoV-2 infection poses a significant risk for acute and long-term cardiovascular complications.
- Patients with COVID-19 face increased mortality and a wide spectrum of post-acute cardiac issues.
- Understanding these complications is vital for effective patient management.
Purpose of the Study:
- To provide an updated clinical overview of diagnosing and treating cardiovascular manifestations of COVID-19.
- To review current evidence on acute and post-acute cardiovascular complications, symptomatology, and pathophysiology.
- To discuss therapeutic strategies and identify at-risk populations.
Main Methods:
- Comprehensive literature review of clinical studies on COVID-19 and cardiovascular complications.
- Analysis of diagnostic and treatment approaches for acute and long-term cardiovascular sequelae.
- Identification of patient populations at higher risk for adverse outcomes.
Main Results:
- COVID-19 is associated with increased myocardial injury, heart failure, dysrhythmias, and coagulation abnormalities.
- Cardiovascular complications persist beyond 30 days post-infection, regardless of comorbidities, but high-risk groups (elderly, hypertensive, diabetic) experience worse outcomes.
- Low-dose propranolol may manage tachycardia, ACE inhibitors/ARBs should not be withdrawn, and extended thromboprophylaxis with rivaroxaban improved outcomes in high-risk patients.
Conclusions:
- COVID-19 leads to significant cardiovascular complications during both acute and long-term phases.
- Prompt diagnosis and tailored management, including potential use of propranolol and rivaroxaban, are essential.
- Older patients with pre-existing conditions are particularly vulnerable and require focused attention.
Purpose Of Review:
The risk of cardiovascular complications due to SARS-CoV-2 are significantly increased within the first 6 months of the infection. Patients with COVID-19 have an increased risk of death, and there is evidence that many may experience a wide range of post-acute cardiovascular complications. Our work aims to provide an update on current clinical aspects of diagnosis and treatment of cardiovascular manifestations during acute and long-term COVID-19.
Recent Findings:
SARS-CoV-2 has been shown to be associated with increased incidence of cardiovascular complications such as myocardial injury, heart failure, and dysrhythmias, as well as coagulation abnormalities not only during the acute phase but also beyond the first 30 days of the infection, associated with high mortality and poor outcomes. Cardiovascular complications during long-COVID-19 were found regardless of comorbidities such as age, hypertension, and diabetes; nevertheless, these populations remain at high risk for the worst outcomes during post-acute COVID-19. Emphasis should be given to the management of these patients. Treatment with low-dose oral propranolol, a beta blocker, for heart rate management may be considered, since it was found to significantly attenuate tachycardia and improve symptoms in postural tachycardia syndrome, while for patients on ACE inhibitors or angiotensin-receptor blockers (ARBs), under no circumstances should these medications be withdrawn. In addition, in patients at high risk after hospitalization due to COVID-19, thromboprophylaxis with rivaroxaban 10 mg/day for 35 days improved clinical outcomes compared with no extended thromboprophylaxis. In this work we provide a comprehensive review on acute and post-acute COVID-19 cardiovascular complications, symptomatology, and pathophysiology mechanisms. We also discuss therapeutic strategies for these patients during acute and long-term care and highlight populations at risk. Our findings suggest that older patients with risk factors such as hypertension, diabetes, and medical history of vascular disease have worse outcomes during acute SARS-CoV-2 infection and are more likely to develop cardiovascular complications during long-COVID-19.
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