Cardiovascular complications in the Post-Acute COVID-19 syndrome (PACS)

• Published in: International journal of cardiology. Heart & vasculature Vol. 40; p. 101012
• Main Authors: Elseidy, Sheref A., Awad, Ahmed K., Vorla, Monica, Fatima, Amina, Elbadawy, Merihan A., Mandal, Debvarsha, Mohamad, Tamam
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-06-2022; Elsevier
• Subjects: Cardiovascular diseases; COVID-19; Myocardial infarction; Post covid sequelae; Review; Myocardial infarction; TMPRS2; IL; PACS; TTE; VTE; RAAS; NOAC; TNF-Alpha; CMR; DAMPs; COVID-19; CVD; CAMKII; ACE2; UFH; Post covid sequelae; Cardiovascular diseases; SARS-CoV 2; WHO; DAMPs, damage-associated molecular patterns; VTE, venous thromboembolism; RAAS, Renin-Angiotensin Aldosterone System dysregulation; TTE, transthoracic echocardiogram; CMR, Cardiac magnetic resonance imaging; UFH, Unfractionated heparin; CAMKII, calmodulin-dependent protein kinase II; COVID-19, Coronavirus disease 2019; PACS, Post-Acute COVID-19 syndrome; SARS-CoV 2, severe acute respiratory syndrome coronavirus 2; TMPRS2, transmembrane protease serine 2; IL, interleukin; NOAC, novel oral anticoagulation; CVD, Cardiovascular disease; ACE2, Angiotensin-converting enzyme 2; WHO, World health organization; TNF-Alpha, Tumor necrosis factor-alpha
• DOI: 10.1016/j.ijcha.2022.101012
• EISSN: 2352-9067

•The presence of stress-related (Takotsubo) cardiomyopathy has also been demonstrated in COVID-19.•The proposed mechanisms of cardiac damage during the acute phase of COVID-19 include both direct -viral penetration- and indirect routes -hypoxic injury and systemic inflammation.•SARS-CoV-2 infection, especially in its severe form, is associated with an increased risk for venous thromboembolism (VTE).•Unfractionated heparin (UFH) is the first-line treatment for hemodynamic instability and emergency reperfusion for PASC.•Further studies are needed to offer current screening for the occurrence of cardiovascular problems especially myocardial infarction and heart failure in COVID-19 patients.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) or coronavirus disease 2019 (COVID-19) initially surfaced in December 2019 from Wuhan, China, sweeping the world with various strains, forcing the WHO to declare a pandemic epidemic in March 2020. Furthermore, COVID-19 manifests with a wide array of presentations from fever and fatigue to severe respiratory and cardiovascular complications. Post-COVID-19 syndrome is poorly understood affecting COVID-19 survivors at all levels of disease severity. The disease is most associated with post-discharge dyspnea and fatigue. However, other persistent symptoms as chest pains, palpitations, smell, and taste dysfunctions. Patients with high concentrations of CRP and creatinine in the acute phase of Covid-19 are more prone to cardiac sequelae. Therefore, high levels of cardiac-sensitive troponin and hypokalaemia can also be used for risk stratification. Furthermore, Cardiac damage can manifest as myocarditis, pericarditis, rhythm abnormalities. The use of different diagnostic modalities like electrocardiogram (ECG), echocardiogram, and cardiac magnetic resonance imaging (MRI)(CMR) to evaluate the myocardial damage were studied. However, Cardiovascular complications are a common manifestation of PASC, classification of severity of cardiac symptoms and the emergence of CMR as a diagnostic tool needs more evidence.