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There is limited literature on the cardiovascular manifestations of post-acute sequelae of SARS-CoV-2 infection (PASC). We aimed to describe the characteristics, diagnostic evaluations, and cardiac diagnoses in patients referred to a cardiovascular disease clinic designed for patients with PASC from May 2020 to September 2021. Of 126 patients, average age was 46 years (range 19-81 years), 43 (34%) were male. Patients presented on average five months after COVID-19 diagnosis. 30 (24%) patients were hospitalized for acute COVID-19. Severity of acute COVID-19 was mild in 37%, moderate in 41%, severe in 11%, and critical in 9%. Patients were also followed for PASC by pulmonology (53%), neurology (33%), otolaryngology (11%), and rheumatology (7%). Forty-three patients (34%) did not have significant comorbidities. The most common symptoms were dyspnea (52%), chest pain/pressure (48%), palpitations (44%), and fatigue (42%), commonly associated with exertion or exercise intolerance. The following cardiovascular diagnoses were identified: nonischemic cardiomyopathy (5%); new ischemia (3%); coronary vasospasm (2%); new atrial fibrillation (2%), new supraventricular tachycardia (2%); myocardial involvement (15%) by cardiac MRI, characterized by late gadolinium enhancement (LGE; 60%) or inflammation (48%). The remaining 97 patients (77%) exhibited common symptoms of fatigue, dyspnea on exertion, tachycardia, or chest pain, which we termed “cardiovascular PASC syndrome.” Three of these people met criteria for postural orthostatic tachycardia syndrome. Lower severity of acute COVID-19 was a significant predictor of cardiovascular PASC syndrome. In this cohort of patients referred to cardiology for PASC, 23% had a new diagnosis, but most displayed a pattern of symptoms associated with exercise intolerance.

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Recent trials show a lack of benefit of routine aspirin use for primary prevention and potential for harm. We assessed recent trends in aspirin use for both primary and secondary prevention in the United States population Methods: We used National Health Interview Survey (NHIS) data from 2015-2021 and reported the annual weighted proportion of aspirin use among patients ≥40 years without a self-reported history of angina, coronary heart disease, myocardial infarction, or stroke (primary prevention cohort) and those with (secondary prevention cohort) overall and by subgroups of sex, age ≥70 years and diabetes status. Results: The proportion of patients on aspirin for primary prevention reduced from 24.8% in 2015 to 13.9% in 2021 and secondary prevention reduced from 67.6% to 45.9%. The reduction in aspirin use was observed across all subgroups and in both cohorts. Conclusion: In response to recent data regarding lack of benefit of aspirin for primary prevention there has been a significant reduction in aspirin use for both primary and secondary prevention, the latter may be unintended and warrants further scrutiny.

Pulmonary arterial hypertension (PAH) is characterized by progressive pulmonary vascular remodeling with resultant abnormal increase in pulmonary artery pressure and right heart dysfunction. There is evidence that PAH includes cognitive impairment. However, the cognitive impairment syndrome has not been well described, and both the underlying mechanism and the relationship between cardiopulmonary and cognitive dysfunction in PAH are unknown. We performed cognitive evaluations and same day sub‐maximum cardiopulmonary exercise testing on adult subjects with PAH. A frontal–subcortical syndrome suggestive of vascular cognitive impairment was found in 26% of subjects and was associated with noninvasive markers of pulmonary vascular remodeling.