Late phase of COVID‐19 pandemic in General Cardiology. A position paper of the ESC Council for Cardiology Practice

Abstract

Cardiovascular (CV) engagement in coronavirus disease 2019 (COVID‐19) is a huge determinant of prognosis during the acute phase of the disease. However, little is known about the potential chronic implications of the late phase of COVID‐19 and about the appropriate approach to these patients. Heart failure, type 1 and type 2 myocardial infarction, arrhythmias, myocarditis, pulmonary fibrosis, and thrombosis have been shown to be related to severe acute respiratory syndrome coronavirus 2 infection, and a ‘long COVID‐19’ illness has been recognized with fatigue, chest pain, and dyspnoea among the most frequent symptoms reported after discharge from hospital. This paper focuses on some open questions that cardiologists are going to face during the next months in a general cardiology outpatient clinic, in particular how to evaluate a ‘post‐COVID’ patient during follow‐up of CV complications of the acute phase and how to manage new CV symptoms that could be the consequence, at least in part, of heart/vessels and/or lung involvement of the previous virus infection. Present symptoms and signs, history of previous CV disease (both preceding COVID‐19 and occurring during viral infection), and specific laboratory and imaging measurements during the acute phase may be of interest in focusing on how to approach the clinical evaluation of a post‐COVID patient and how to integrate in our standard of care the new information on COVID‐19, possibly in a multidisciplinary view. Dealing with the increased COVID‐associated CV risk burden and becoming acquainted with potential new e‐cardiology approaches aimed at integrating the cardiology practice are relevant new challenges brought by severe acute respiratory syndrome coronavirus 2 infection and its sequelae.

Diabetes, Heart Failure, and COVID-19: An Update

“…Just a small increase in the incidence of diabetes or cardiac dysfunction could have profound consequences in overall health burden and number of required screening exams. Currently, some members of the European Society of Cardiology posit that we reasonably might screen (or continue to monitor) for cardiac dysfunction in (1) patients who had demonstrated cardiac dysfunction during their COVID infection; (2) patients with clinical symptoms of dyspnea, exercise intolerance, long COVID symptoms; (3) anyone who had elevated cardiac troponin levels during infection (Richter et al, 2021). Arguments for screening the latter group seem supported by the evidence in Puntmann et al (2020).…”

2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play

“… 111 , 151 , 152 , 153 Cardiac evaluation in these patients may also fail to identify a specific etiology for their reported symptoms. 154 , 155 , 156 , 157 , 158 Collectively, this can be a source of tremendous frustration for patients and clinicians alike and may lead to significant variation in care.…”

Long-term complications of COVID-19

“…Any patient with known cardiovascular complication of the acute infection and those who go on to develop cardiovascular complaints in the late phase, several weeks to months following acute infection, of the disease should be referred for evaluation by a subspecialist in cardiology ( 35 ). Evaluation of the patient should include comprehensive assessment with a history and physical exam and a 12-lead ECG, with consideration of cardiac biomarkers and cardiovascular imaging as each clinical scenario dictates ( 35 ). As the experience with COVID-19 complications and sequelae continues to grow, it has been proposed to draw on our experiences in non-COVID-19 illnesses to guide our practices ( 36 ).…”