Understanding “Long COVID”: Diagnosis and Treatment of Cardiovascular Symptoms in Patients Recovering from COVID-19

2023-05-16 09:55:14

【Voice of Hope May 16, 2023】 Have persistent heart-related symptoms or new-onset related symptoms, including chest pain, chest tightness, palpitations, shortness of breath, or postural tachycardia 3 months after infection with the new coronavirus, and last for at least 2 months, but there is no abnormality in cardiovascular related examinations, It can be considered as a post-infection state of the new coronavirus, that is, “long new crown”.

Recently, the working group of the European Society of Cardiology (ESC) issued a scientific statement on the diagnosis and treatment strategy of cardiovascular symptoms of new coronary pneumonia.

The statement pointed out that cardiovascular symptoms are the third most common manifestation in patients with new crowns. However, according to the relevant risk factors, the risk of developing new crowns in patients with severe new crowns can be calculated, but it is difficult to predict whether mild and non-hospitalized patients will develop new crowns.

The statement believes that microvascular and large vessel endothelial dysfunction, coagulation disorders and microthrombosis may be the cause of persistent cardiovascular symptoms in patients with new coronary pneumonia.

However, based on current evidence, the persistence of the virus in the myocardium is unlikely to cause the cardiovascular sequelae of COVID-19 infection.

Endothelial cell damage is considered to be the pathological basis of severe COVID-19 patients and leads to long-term cardiovascular complications.

Pathological processes such as microthrombosis, capillary incompleteness, hemodynamic disturbances, and decreased oxygen uptake persist even when no virus is detected.

These pathological processes can lead to dysfunction of microvascular and alveolar gas exchange, which in turn leads to hypoxemia and complications in multiple organs including the heart, brain, lungs, and kidneys.

ESC (official website)

In general, patients with COVID-19 who required hospitalization had more severe cardiovascular symptoms, and patients with asymptomatic or mild-to-moderate symptoms had milder cardiovascular symptoms.

For patients with relevant symptoms, the first step is to exclude clear organic diseases, such as emerging autoimmunity, chronic myocarditis, pulmonary fibrosis, or the progression of previous diseases, such as chronic obstructive pulmonary disease, coronary artery disease, chronic renal function abnormalities, diabetes, autoimmune diseases, etc.

It should be pointed out that in hospitalized patients with elevated troponin, the in-hospital and 12-month mortality rates were as high as 28.6 and 33.2%, respectively.

Some patients have been found to have transient or persistent ECG and Holter abnormalities, including sinus tachycardia, nonspecific ST-segment changes, ST-segment elevation without myocardial injury, T wave abnormalities, QT prolongation, low voltage , New complete or incomplete bundle branch block.

Echocardiographic abnormalities may also be found in patients with new coronary pneumonia, including left and right ventricular remodeling, diastolic and systolic dysfunction, pulmonary hypertension, pericardial effusion, and reduced overall longitudinal strain of the left or right ventricle.

Cardiac magnetic resonance (MRI) examination can reveal persistent myocardial edema, inflammation, fibrosis, impaired left and right ventricular function, and pericardial thickening and/or effusion in patients with new coronary pneumonia.

18F-FDG PET/CT detection of patients with new-onset symptoms of new coronary pneumonia found that the uptake of 18F-FDG-PET in the lateral wall and inferior lateral wall of the left ventricle was high, suggesting “myocardial fatigue syndrome (myocardial fatigue syndrome)”.

But the statement pointed out that it is difficult to say that the abnormalities found in some patient groups also apply to other groups. Although some patients with COVID-19 will develop cardiac abnormalities, in some cases, the problem may have existed before the infection of the new crown. Due to the lack of comparison with the pre-infection, it is difficult to assess the abnormality caused by the infection.

Among the cardiovascular symptoms of new coronary pneumonia, new-onset hypertension and diabetes are as high as 10% and 2.4%, respectively. Studies have found that delayed multisystem inflammatory syndrome (MIS) caused by new coronary pneumonia is accompanied by cardiovascular involvement of Kawasaki syndrome. MIS is a rare complication characterized by systemic hyperinflammation with cardiovascular disease.

Most biomarker studies are small sample studies and lack definitive diagnosis of prior viral infection, longitudinal evaluation, appropriate matched control groups to identify specific biomarkers for COVID-19, and did not use independent populations to assess the relationship between biomarkers and heart disease. Correlation of vascular symptoms in long-term COVID-19 patients.

There is currently a lack of specific biomarkers for long-term new crowns. None of the existing circulating biomarkers, coagulation and inflammation markers are highly predictive of the presence or prognosis of COVID-19.

Further studies are needed to assess the longitudinal evolution of these biomarkers during COVID-19, and metabolic phenotype studies have been used to find new predictive markers for COVID-19, but are at an exploratory stage.

cardiovascular disease (pixabay)
cardiovascular disease (pixabay)

A position paper on the assessment and management of cardiovascular symptoms in patients with COVID-19 issued by the ESC Cardiology Practice Committee states that cardiovascular symptoms of COVID-19 are difficult to associate with other organ diseases such as pulmonary fibrosis, chronic thromboembolism, gastrointestinal or peripheral muscle or joint disease Caused by cardiac fatigue syndrome distinction.


(1) After the new crown PCR test turns negative, all patients with new crown should be routinely tested for troponin, so that more subclinical cardiac complications can be found.

(2) For all patients with new coronary pneumonia, CRP, D-dimer, electrocardiogram, chest X-ray and disease status (including kidney, muscle and bone, rheumatism, etc.) should be checked.

(3) Check the heart condition of patients with symptoms and a history of heart disease one month after the new crown infection, including electrocardiogram, laboratory examination, cardiac ultrasound, dynamic electrocardiogram, chest X-ray and lung function, etc.

(4) For asymptomatic patients with a history of heart disease but 3 months after the new crown infection, use electrocardiograms, laboratory tests, and cardiac ultrasound to screen for heart disease. Further specific investigations (eg, stress test, Holter) should be considered if necessary.

(5) Conduct electrocardiogram and laboratory tests on long-term new crown patients with mild to moderate new crown infection who are symptomatic, not hospitalized and have no history of cardiovascular disease. Elective echocardiography, dynamic electrocardiography, chest X-ray and lung function tests.

electrocardiogram (pixabay)
electrocardiogram (pixabay)

(6) Athletes undergo cardiac MRI examination before extensive exercise.

(7) All hospitalized patients with new crowns, long-term new crown patients with cardiovascular disease history and cardiovascular symptoms should undergo cardiovascular rehabilitation.

(8) Carry out cardiac MRI examination for patients with new cardiovascular disease after new crown infection.

Article source: China Cycle Magazine

Responsible editor: Li Wenhan

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