Cardiovascular Considerations in the Management of People With Suspected Long COVID

• Published in: Canadian journal of cardiology 2023-06, Vol.39 (6), p.741-753
• Main Authors: Quinn, Kieran L., Lam, Grace Y., Walsh, Jillian F., Bhéreur, Anne, Brown, Adam D., Chow, Chung Wai, Chung, Kit Yan Christie, Cowan, Juthaporn, Crampton, Noah, Décary, Simon, Falcone, Emilia L., Graves, Lorraine, Gross, Douglas P., Hanneman, Kate, Harvey, Paula J., Holmes, Sheila, Katz, Gabrielle M., Parhizgar, Parinaz, Sharkawy, Abdu, Tran, Karen C., Waserman, Susan, Zannella, Vanessa E., Cheung, Angela M.
• Format: Article
• Language: English
• Subjects: Adult; Canada - epidemiology; COVID-19 - complications; COVID-19 - epidemiology; COVID-19 - therapy; Heart; Humans; Post-Acute COVID-19 Syndrome; SARS-CoV-2
• ISSN: 0828-282X; 1916-7075; 1916-7075
• DOI: 10.1016/j.cjca.2023.04.003

Approximately 15% of adult Canadians with SARS-CoV-2 infection develop lingering symptoms beyond 12 weeks after acute infection, known as post-COVID condition or long COVID. Some of the commonly reported long COVID cardiovascular symptoms include fatigue, shortness of breath, chest pain, and palpitations. Suspected long-term cardiovascular complications of SARS-CoV-2 infection might present as a constellation of symptoms that can be challenging for clinicians to diagnose and treat. When assessing patients with these symptoms, clinicians need to keep in mind myalgic encephalomyelitis/chronic fatigue syndrome, postexertional malaise and postexertional symptom exacerbation, dysautonomia with cardiac manifestations such as inappropriate sinus tachycardia, and postural orthostatic tachycardia syndrome, and occasionally mast cell activation syndrome. In this review we summarize the globally evolving evidence around management of cardiac sequelae of long COVID. In addition, we include a Canadian perspective, consisting of a panel of expert opinions from people with lived experience and experienced clinicians across Canada who have been involved in management of long COVID. The objective of this review is to offer some practical guidance to cardiologists and generalist clinicians regarding diagnostic and treatment approaches for adult patients with suspected long COVID who continue to experience unexplained cardiac symptoms. Environ 15 % des adultes canadiens atteints d’une infection à SRAS-CoV-2 présentent des symptômes qui persistent plus de 12 semaines après la phase aiguë de l’infection, ce qu’on appelle le syndrome post-COVID ou la COVID longue. Certains des symptômes cardiovasculaires courants rapportés dans les cas de COVID longue comprennent la fatigue, l’essoufflement, les douleurs à la poitrine et les palpitations. Les complications cardiovasculaires à long terme présumées de l’infection à SRAS-CoV-2 pourraient se présenter sous la forme d’un ensemble de symptômes difficiles à diagnostiquer et à traiter pour les cliniciens. Lors de l’évaluation des patients présentant ces symptômes, les cliniciens doivent garder en tête l’encéphalomyélite myalgique, ou syndrome de fatigue chronique, le malaise post-effort et l’exacerbation des symptômes post-effort, la dysautonomie avec manifestations cardiaques comme une tachycardie sinusale inappropriée, et le syndrome de tachycardie orthostatique posturale, et parfois le syndrome d’activation mastocytaire. Dans cette