Unmasking Pandemic Echoes: An In-Depth Review of Long COVID’s Unabated Cardiovascular Consequences beyond 2020

Abstract

At the beginning of 2020, coronavirus disease 2019 (COVID-19) emerged as a new pandemic, leading to a worldwide health crisis and overwhelming healthcare systems due to high numbers of hospital admissions, insufficient resources, and a lack of standardized therapeutic protocols. Multiple genetic variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been detected since its first public declaration in 2020, some of them being considered variants of concern (VOCs) corresponding to several pandemic waves. Nevertheless, a growing number of COVID-19 patients are continuously discharged from hospitals, remaining symptomatic even months after their first episode of COVID-19 infection. Long COVID-19 or ‘post-acute COVID-19 syndrome’ emerged as the new pandemic, being characterized by a high variability of clinical manifestations ranging from cardiorespiratory and neurological symptoms such as chest pain, exertional dyspnoea or cognitive disturbance to psychological disturbances, e.g., depression, anxiety or sleep disturbance with a crucial impact on patients’ quality of life. Moreover, Long COVID is viewed as a new cardiovascular risk factor capable of modifying the trajectory of current and future cardiovascular diseases, altering the patients’ prognosis. Therefore, in this review we address the current definitions of Long COVID and its pathophysiology, with a focus on cardiovascular manifestations. Furthermore, we aim to review the mechanisms of acute and chronic cardiac injury and the variety of cardiovascular sequelae observed in recovered COVID-19 patients, in addition to the potential role of Long COVID clinics in the medical management of this new condition. We will further address the role of future research for a better understanding of the actual impact of Long COVID and future therapeutic directions.

Low-dose naltrexone and NAD+ for the treatment of patients with persistent fatigue symptoms after COVID-19

“…Long COVID has been associated with a wide array of symptoms, including cough, dyspnea, chest pain, palpitations, abdominal pain, nausea, cognitive impairment, persistent and severe fatigue, neurocognitive dysfunction including brain fog, tinnitus, post-exertional malaise, orthostatic intolerance, and sleep disruptions (reviewed in Davis et al, 2023 ) ( Davis et al, 2023 )). Furthermore, long-term consequences of acute infections and long COVID have been reported as risk factors for various diagnoses including cardiovascular disease ( Luchian et al, 2023 ), postural orthostatic tachycardia syndrome (POTS) ( Luchian et al, 2023 ), and new-onset diabetes ( Harding et al, 2023 ). Additionally, many long COVID symptoms overlap with symptoms of ME/CFS, suggesting the clinical presentation of these conditions to be similar ( Komaroff and Lipkin, 2023 ; Wong and Weitzer, 2021 ).…”

Community-Based View on Diagnostic Imaging at the End of COVID-19 Pandemic: Online Survey-Assisted Study

“…Previous data showed the involvement of cardiovascular system into the pathogenesis of long COVID suggesting the need for consistent use of diagnostic algorithms aimed at ruling out the 2 inflammatory changes in the myocardium as it may be lifesaving [2,3,7]. Beside cardiovascular involvement, long COVID manifests with multiple conditions [8] including thrombotic and cerebrovascular abnormalities [9], type 2 diabetes mellitus [10], myalgic encephalomyelitis [11,12], and autonomic failure [12].…”

Community-Based View on Diagnostic Imaging at the End of COVID-19 Pandemic: Online Survey-Assisted Study

“…A successful vaccination campaign decreased global burden of acute COVID-19, but large groups of the population continue suffering from persisting symptoms of post-COVID-19 syndrome or long COVID [ 4 , 5 ], while the waves of COVID-19 tend to reoccur [ 6 ]. Previous data showed the involvement of the cardiovascular system in the pathogenesis of long COVID, suggesting the need for consistent use of diagnostic algorithms aimed at ruling out the inflammatory changes in the myocardium as it may be lifesaving [ 2 , 3 , 7 ]. Besides cardiovascular involvement, long COVID manifests with multiple conditions [ 8 ], including thrombotic and cerebrovascular abnormalities [ 9 ], type 2 diabetes mellitus [ 10 ], myalgic encephalomyelitis [ 11 , 12 ], and autonomic failure [ 12 ].…”