Cardiovascular implications of the COVID-19 pandemic

Abstract

The COVID-19 pandemic has rapidly emerged as one of the biggest public health concerns of the 21 st century. Although it was initially reported as a cluster of pneumonia cases, it quickly became apparent that COVID-19 is not merely a respiratory tract infection. Its clinical course is often complicated by cardiovascular manifestations including venous and arterial thrombosis, electrical disturbances, and myocardial damage. In addition, the cardiovascular system is involved not only during infection but also preceding the contraction of the virus; having cardiovascular comorbidities indicates significant vulnerability to the pathogen. As longer-term data continue to accumulate, we now have concerns over its lasting cardiovascular effects after recovery. Moreover, there have been substantial collateral effects on the epidemiology of cardiovascular diseases. Reports of adverse cardiovascular events from vaccination have emerged as new hurdles to our efforts to bring an end to the pandemic. As such, the association between COVID-19 and the cardiovascular system and cardiovascular practice in general is expansive. In this review, we provide an overview of the knowledge and considerations in this field, based on the evidence available at the time of this writing.

Impact of serum lactate dehydrogenase on the short-term prognosis of COVID-19 with pre-existing cardiovascular diseases

“…In a report of 1,591 patients with COVID-19 who were admitted to an intensive care unit in Italy, 49% of the patients had pre-existing hypertension, 21% had cardiovascular disease, and 17% had diabetes [15] . COVID-19 not only causes viral pneumonia but also triggers cardiovascular disorders, such as myocardial injury, arrhythmias, acute coronary syndrome, and thromboembolism [16] , [17] , [18] , [19] , [20] , [21] . The mechanism by which SARS-CoV-2 affects the heart is not clear.…”

Multi‐disciplinary collaborative consensus guidance statement on the assessment and treatment of cardiovascular complications in patients with post‐acute sequelae of SARS‐CoV‐2 infection (PASC)

“…Elevation of serum cardiac troponins is reported with COVID‐19 related myocarditis, myocardial injury/ischemia, and infarction 40 . The level of troponin elevation is closely related to the severity of both myocardial injury and risk of cardiovascular mortality post infection 45 . Troponin elevation may also be associated with noncardiovascular complications including sepsis, acute kidney failure, and major bleeding 46 .…”

“…Where indicated, clinicians requiring assistance in interpretation of vital signs for return to activity a referral to a clinical exercise physiologist or physical therapist for appropriate activity prescription should be considered. Specifying vital sign parameters for training intensities when referring patients to sports trainers can be considered according to the ACC 2022 Expert Consensus 45 . Note the existing literature on athletes return to exercise and play is generally not aimed at providing guidance for people with a preexisting disability (eg, athletes with spinal cord injury) or comorbidities.…”

“… 40 The level of troponin elevation is closely related to the severity of both myocardial injury and risk of cardiovascular mortality post infection. 45 Troponin elevation may also be associated with noncardiovascular complications including sepsis, acute kidney failure, and major bleeding. 46 In individuals with PASC with ongoing chest pain, a basic screening serum troponin, and EKG can be considered to confirm, or rule out, myocardial injury as a source of the chest pain and to determine the extent and severity of myocardial injury.…”

“…Specifying vital sign parameters for training intensities when referring patients to sports trainers can be considered according to the ACC 2022 Expert Consensus. 45 Note the existing literature on athletes return to exercise and play is generally not aimed at providing guidance for people with a preexisting disability (eg, athletes with spinal cord injury) or comorbidities. Athletes with disabilities, such as spinal cord injury, limb loss, and other neurologic conditions, have unique physical, functional, athletic, and medical needs requiring a more specialized approach to sports participation.…”