A Post-Pandemic Enigma: The Cardiovascular Impact of Post-Acute Sequelae of SARS-CoV-2

Abstract

COVID-19 has become the first modern-day pandemic of historic proportion, affecting >600 million individuals worldwide and causing >6.5 million deaths. While acute infection has had devastating consequences, postacute sequelae of SARS-CoV-2 infection appears to be a pandemic of its own, impacting up to one-third of survivors and often causing symptoms suggestive of cardiovascular phenomena. This review will highlight the suspected pathophysiology of postacute sequelae of SARS-CoV-2, its influence on the cardiovascular system, and potential treatment strategies.

Persistent chest pain following COVID‐19 infection – A scoping review

“…In this review, cardiac imaging studies described cMRI abnormalities suggestive of myocardial scarring, sonographic sequelae, microvascular abnormalities per FMD scores or prior COVID infection as predictors of an abnormal SPECT‐MPI. Some studies propose that risk of myocarditis in the population with PASC appears to be lower than previously thought and suggest poor correlation with chest pain 10 . However, per one study, persistent cMRI cardiac abnormalities were found in 78% of patients irrespective of symptoms (87% patients were without chest pain at testing) at 2 weeks or later after infection and myocardial inflammation in 60% of patients 84 .…”

“…About 48%–55.6% of patients affected by long COVID are women 2,3 . Importantly, persons identifying with racial and ethnic minority groups have not only a higher incidence of COVID‐19 acute infection/disease, hospitalization, morbidity, and mortality but also have been found to have a higher incidence of long COVID 9,10 . In addition, pregnant women are disproportionately affected with increased maternal and fetal morbidity due to the acute infection, and long COVID symptoms in pregnancy and their effects on their offsprings are under investigation 11–13 …”

COVID-19 and the Cardiovascular System: Requiem for a Medical Minotaur

“…Third, based on virtually identical patterns of altered gene expression in mRNA vaccine associated myocardial injury and COVID-19 infection, these disorders may have a common pathobiology, related to the cellular response to Spike protein-ACE2 binding and internalization. 10,11 The reported incidence, consequences, and pathophysiology of post-acute sequelae of SARS-CoV-2 (PASC) are reviewed by Singh et al 12 Though the COVID-19 pandemic may be sundowning, its long-term effects are persisting in up to 20-25% of patients after COVID-19 infection; the precise incidence has been limited by varying definitions of PASC. Opposite to myocarditis, PASC seems to be associated with female gender, older age, and lack of SARS-CoV-2 vaccination, but not with severity of acute infection.…”

“…The reported incidence, consequences, and pathophysiology of post-acute sequelae of SARS-CoV-2 (PASC) are reviewed by Singh et al 12 Though the COVID-19 pandemic may be sundowning, its long-term effects are persisting in up to 20-25% of patients after COVID-19 infection; the precise incidence has been limited by varying definitions of PASC. Opposite to myocarditis, PASC seems to be associated with female gender, older age, and lack of SARS-CoV-2 vaccination, but not with severity of acute infection.…”

“…The authors summarize data from various repurposing efforts including high-throughput drug library screening in cell lines infected with virus or bearing SARS-CoV-2 targets, omics data-based drug re-positioning, and their own network module-based approach. 12 Identified by these repurposing methods were the RNA dependent RNA polymerase (RdRp) inhibitor remdesivir (Veklury), the 3C-like protease inhibitor nelfinavir (Paxlovid) and the RdRp inhibitor molnupiravir (Lagevrio), which had been in development for other indications before the pandemic and eventually gained emergency use approval for COVID-19.…”