“The National Institute for Health and Care Excellence in the United Kingdom has defined long COVID as a persistence of symptoms beyond 4 weeks and has subdivided this into 2 categories: the ‘ongoing symptomatic phase,’ which refers to symptoms up to 12 weeks and the ‘post-COVID-19 syndrome,’ which refers to symptoms that persist beyond 12 weeks,” stated Dr Betty Raman (John Radcliffe Hospital, University of Oxford, UK) [1]. There is a vast multiplicity of patient-reported COVID-19 symptoms beyond 4 weeks, among which fatigue is most common [2–4]. Other widespread symptoms include shortness of breath, headaches, brain fog, and cardiopulmonary symptoms such as chest pain or palpitations. A poorly understood but not rare syndrome in long COVID is postural orthostatic tachycardia. Long COVID patients not only experience a marked reduction in quality of life, but a substantial part is also not able to return to work and normal exercise [1].
Results from a meta-analysis of over 4,000 hospitalised COVID-19 patients, found some sort of myocardial injury in about one-third of patients [5]. An imaging investigation demonstrated, for example, wall motion impairment, right ventricular dysfunction, and pericardial effusion in hospitalised COVID-19 patients [6]. Retrospective cohort studies revealed a 3-fold risk of major adverse cardiac events and a 2 to 3-fold risk of cardiomyopathy in patients after the acute phase of COVID-19 versus a comparator group without COVID-19 [7,8]. There is also prospective data from several smaller cohort studies with hospitalised COVID-19 patients [1]. “All of them do reveal some burden, albeit small, of ongoing cardiac damage in patients being followed up,” Dr Raman explained. Data from cardiopulmonary exercise testing has furthermore found that the main aetiology for reduced exercise tolerance seems to stem from a muscular cause, not cardiopulmonary.
In summary, Dr Raman pointed out that post-acute cardiovascular sequelae are seen for up to 6 months from infection. “However, there does appear to be a dissociation between symptoms experienced by patients and objective abnormalities on cardiopulmonary testing and in the long-term, one must be vigilant of complications of long COVID, in particular the effects of chronic inflammation and endothelial dysfunction, but also the rising epidemic of obesity due to inability of people to become physically active and return to work. This highlights the need for more aggressive risk factor modification in patients recovering from COVID-19,” she concluded.
- Raman B. COVID-19 long haulers and cardiovascular risks. Session: Long COVID: does it matter? ESC Congress 2021, 27–30 August.
- Ghosn J, et al. Clin Microbiol Infect. 2021;27(7):1041.e1-1041.e4.
- Huang C, et al. Lancet. 2021;397:220–232.
- Davis HE, et al. EClinicalMedicine 2021;38:101019.
- Dy LF, et al. Sci Rep. 2021;11(1):8449.
- Giustino G. J Am Coll Cardiol. 2020;76(18):2043–2055.
- Ayoubkhani D, et al. BMJ 2021;372:n693.
- Daugherty SE, et al. BMJ 2021;373:n1098.
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Table of Contents: ESC 2021
Featured articles
2021 ESC Clinical Practice Guidelines
2021 ESC Guidelines on Heart Failure
2021 ESC/EACTS Guidelines on Valvular Heart Disease
2021 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronisation Therapy
2021 ESC Guidelines on Cardiovascular Disease Prevention
Best of the Hotline Sessions
Empagliflozin: First drug with clear benefit in HFpEF patients
CardioMEMS: neutral outcome but possible benefit prior to COVID-19
Cardiac arrest without ST-elevation: instant angiogram does not improve mortality
Older hypertensive patients benefit from intensive blood pressure control
Antagonising the mineralocorticoid receptor beneficial for patients with diabetes and CKD
Late-Breaking Science in Heart Failure
Valsartan seems to attenuate hypertrophic cardiomyopathy progression
Dapagliflozin reduces incidence of sudden death in HFrEF patients
Late-Breaking Science in Hypertension
Smartphone app improves BP control independent of age, sex, and BMI
QUARTET demonstrates that simplicity is key in BP control
Salt substitutes: a successful strategy to improve blood pressure
Late-Breaking Science in Prevention
NATURE-PCSK9: Vaccine-like strategy successful in lowering CV events
Polypill: A successful tool in primary prevention
Important Results in Special Populations
VOYAGER PAD: Fragile or diabetic patients also benefit from rivaroxaban
COVID-19 and the Heart
Rivaroxaban improves clinical outcomes in discharged COVID-19 patients
COVID-19: Thromboembolic risk reduction with therapeutic heparin dosing
Long COVID symptoms – Is ongoing cardiac damage the culprit?
ESC Spotlight of the Year 2021: Sudden Cardiac Death
Breathing problems: the most frequently reported symptom before cardiac arrest
Lay responders can improve survival in out-of-hospital cardiac arrest
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QUARTET demonstrates that simplicity is key in BP control
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2021 ESC Guidelines on Cardiovascular Disease Prevention
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