Cardiovascular (CV) events associated with acute COVID-19 infection include myocardial infarction (MI), arrhythmias, multisystem inflammatory syndrome, stroke, embolism, and bleeding disorders. Some patients who recover from acute COVID-19 suffer ongoing health challenges. Satterfield et. al. propose 4 categories to consider CV sequelae in COVID survivors.
Asymptomatic, mild, or moderate COVID-19, and persistent symptoms
The prevalence of so-called “post-COVID syndrome,” or “long-hauler” symptoms is unknown. The most common persistent symptom is dyspnea. Other CV symptoms include arrhythmias, chest pain, palpations, and tachycardia. Neurological symptoms, mental health effects, fatigue, arthralgia, and myalgia are also reported. The pathogenesis is considered to be multifactorial, with prolonged inflammation being a major contributing factor.
Mild COVID-19 and abnormal cardiac MRI
Initial studies showed abnormalities in lab values, echocardiograms, and MRI in COVID survivors. Subsequent studies, however, have been inconsistent. Some have reported abnormal cardiac MRIs at higher levels in COVID survivors than in the general population, while others have reported that rates of imaging and lab abnormalities do not differ significantly between COVID survivors and matched healthy controls.
Moderate-to-severe COVID-19
Patients with moderate-to-severe COVID who required hospitalization seemed to experience poorer outcomes than those not who did not. Some evidence points to lingering left and right ventricular dysfunction in COVID survivors. While this dysfunction may be temporary, long term outcomes have not been documented and therefore remain unknown. Increased rates of MI, stroke, venous thromboembolism, pulmonary hypertension, arrhythmias, and heart failure are all anticipated in these patients.
Delayed presentation to hospital for cardiovascular conditions
Due to concerns about the pandemic, some patients delayed going to hospital for urgent CV conditions. This delay is associated with poorer outcomes, including increased rates of cardiogenic shock and mortality. The North American COVID-19 and STEMI (NACMI) registry documented that patients with ST-segment elevation MI and COVID-19 were at higher risk of a composite end point of in-hospital death, stroke, recurrent MI, or repeat revascularization than before the pandemic.
Future directions
The authors recommend clinical studies which explore correlations between imaging abnormalities and pathology or histology, clinical syndromes, and the development of long-term comorbidities. These studies should also consider functional status and symptoms as well as cardiac morbidity.
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Author: Kelly Schoonderwoerd
Original article: Satterfield et. al. Nat Rev Cardiol. 2021 Oct 22; 1-10.
