Features of post-COVID syndrome in patients who had COVID-19: effects on the cardiovascular system

  • Received 22.12.2021

  • Revised 17.01.2022

  • Accepted 23.02.2022



  • 1,248 Views

  • Retrieved from Volume 3, No. 4, 2021

  • Pages 110-118

Summary. At the beginning of the pandemic, COVID-19 was thought to be a short-lived disease. However, in the summer of 2020, the World Health Organization, using available data at the time, reported that some patients had symptoms of exhaustion for weeks or even months. Clinical studies of patients infected with SARS-CoV-2 have shown damage to many organs or systems, including the lungs, brain, kidneys and cardiovascular system. Despite extensive research into the cardiovascular complications of COVID-19 and its mechanisms, a number of unanswered questions remain unresolved. However, it is worth noting, that the study should also identify the target group, terms of screening after initial recovery from COVID-19 and tests, which will help in sorting people, who are at risk. The aim of the study – to analyze modern literature sources on post-COVID syndrome in patients with comorbid COVID-19 and cardiovascular pathology. Materials and Methods. The study examined the scientific publications of recent years, which are available on the Internet, key words "COVID-19", "SARS-CoV-2", key words "COVID-19","SARS-CoV-2", "post-COVID syndrome", "cardiovascular pathology". Results. The presence of cardiovascular disease increases mortality in patients with COVID-19 and cardiovascular damage, including myocarditis, cardiac arrhythmias, endothelial cell lesions, thrombotic events and interstitial myocardial fibrosis, postural orthostatic tachycardia syndrome, observed in individual patients who underwent COVID-19. The main pathophysiology of cardiovascular complications associated with COVID-19, not fully studied, although direct myocardial viral infection and cytokine storm have been suggested as possible mechanisms. Conclusions. The analysis of literature sources substantiates the relevance of the study of post-COVID syndrome in patients with comorbid course of COVID-19 and cardiovascular disease. Defining the role of COVID-19 in the development and progression of cardiovascular disease will pave the way for new approaches to the diagnosis, stratification, monitoring, prevention and treatment of this disease

COVID-19, post-COVID syndrome, cardiovascular pathology

https://doi.org/10.11603/bmbr.2706-6290.2021.4.12615

[1]  Han   Zhu,   June-Wha   Rhee,   Paul   Cheng. Cardiovascular  complications  in  patients  with  COVID-19: Consequences of viral toxicities and host immune respon. Current Cardiology Reports. 2020;32: 1-9.

[2] Destin Groff, Ashley Sun, Anna E. Sentongo. Short-term and long-term rates of postacute sequelae of SARS-CoV-2 Infection. JAMA. 2021;4(10): 1-17.

[3] Ani Nalbandian , Kartik Sehgal,  Aakriti Gupta. Post-acute  COVID-19  syndrome.  Nature  Medicine.  2021;21: 601-5.

[4] Sophie  A.  M.  van  Kessel,  Tim  C.  Olde  Hartman, Cornelia H. M. van Jaarsveld Post-acute and long-COVID-19 symptoms  in  patients  with  mild  diseases:  a  systematic review. Family Practice. 2021;20: 1-9. DOI:10.1093/fampra/cmab076

[5] Shin  Jie  Yong.  Long  COVID  or  post-COVID-19 syndrome:  putative  pathophysiology,  risk  factors,  and treatments. Infectious Diseases. 2021;53(10); 737-54.

[6] Weiyi  Tan,  Jamil  Aboulhosn.  The  cardiovascular burden  of  coronavirus  disease  2019  (COVID-19)  with  a focus on congenital heart disease. International Journal of Cardiolog. 2020;309: 70-7.

[7] Hira  Maab,  Faryal  Mustafa,  Syeda  Javeria Shabbir.  Cardiovascular  impact  of  COVID-19:  an  array of   presentations.  Acta   Biomed.   2021;92(2):   1-10. DOI: 10.23750/abm.v92i2.10299

[8] Shaobo Shi, Bo Shen, Tao Liu. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in  Wuhan,  China.  JAMA  Cardiol.  2020;5(7):  802-10. DOI:10.1001/jamacardio.2020.0950

[9] Mohammad  Madjid,  Payam  Safavi-Naein,  Scott D.  Solomon.  Potential  effects  of  Coronaviruses  on  the cardiovascular system. A review. JAMA Cardiol. 2021;5(7): 831-40. DOI:10.1001/jamacardio.2020.1286

[10] Claudia  Carvalho-Schneider,  Emeline  Laurent, Adrien  Lemaignen.  Follow-up  of  adults  with  noncritical COVID-19 two months after symptom onset. Clin. Microbiol. Infect. 20211;27(2): 258-63.

[11] Chaolin  Huang,  Lixue  Huang,  Yeming  Wang. 6-month consequences of COVID-19 in patients discharged from  hospital:  a  cohort  study.  Lancet.  2021;397:  220-32. DOI: 10.1016/S0140-6736(20)32656-8.

[12] Stephanie  M.  Kochav,  Ellie  Coromilas,  Ani Nalbandian  Cardiac.  Arrhythmias  in  COVID-19  Infection. Circ Arrhythm Electrophysio. 2020;13(60): e008719

[13] Dawei  Wang,  Bo  Hu,  Chang  Hu  Clinical. Characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2021;323(11): 1061-9. DOI:10.1001/jama.2020.1585

[14] Chad M. Colon, James G. Barrios, Joe W. Chiles. Atrial  arrhythmias  in  COVID-19  patients.  JACC  Clin. Electrophysiol. 2020;6(9): 1189-90.

[15] Zhou,  Mi,  Wong.  Chun-Ka,  Un,  Ka-Chun. Cardiovascular  sequalae  in  uncomplicated  COVID-19 survivors. PLoS One. 2021;16(2): e0246732.

[16] Enrico  Guido  Spinoni,  Marco  Mennuni,  Andrea Rognon.  Contribution  of  atrial  аibrillation  to  in-hospital mortality  in  patients  with  COVID-19.  Circ  Arrhythm Electrophysiol.  2021;14(2):  e009375.  DOI:  10.1161/CIRCEP.120.009375

[17] Blitshteyn  S,  Whitelaw  S.  Postural  orthostatic tachycardia  syndrome  (POTS)  and  other  autonomic disorders  after  COVID-19  infection:  a  case  series  of  20 patients. Immunol Res. 2021;69: 205-11.

[18] Thomas F O’Connell, Christopher J Bradley, Amr E Abbas.  Hydroxychloroquine/azithromycin  therapy  and  QT prolongation in hospitalized patients with COVID-19. JACC Clin Electrophysiol. 2021;7(1): 16-25.

[19] Ohad Oren, Eric H. Yang, Ty J. Gluckman. Use of chloroquine  and  hydroxychloroquine  in  COVID-19  and cardiovascular  implications.  Circ Arrhythm  Electrophysiol. 2020;13(6): e008688.

[20] Farnaz   Farshidfar,   Navid   Koleini,   Hossein Ardehalicorresponding.  Cardiovascular  complications  of COVID-19. JCI Insight. 2021;6(13): e148980.

[21] Jia Hui Zeng1, Ying Xia Liu2, Jing Yuan. First case of COVID 19 complicated with fulminant myocarditis: a case report and insights.Infection. 2020;10: 1-5. DOI: 10.1007/s15010-020-01424-5

[22] Daniel  S.  Knight,  Tushar  Kotecha,  Yousuf Razvi.   COVID-19:   Myocardial   injury   in   survivors. Circulation.   2020;142(11):   1120-2.   DOI:   10.1161/CIRCULATIONAHA.120.049252

[23] Valentina  O  Puntmann,  M  Ludovica  Carerj,  Imke Wieters. Outcomes of cardiovascular magnetic resonance imaging  in  patients  recently  recovered  from  Coronavirus disease  2019  (COVID-19).  JAMA  Cardiol.  2020;5(11): 1265-73. DOI: 10.1001/jamacardio.2020.3557.

[24] Qiurong Ruan , Kun Yang, Wenxia Wang. Clinical predictors  of  mortality  due  to  COVID-19  based  on  an analysis  of  data  of  150  patients  from  Wuhan,  China. Intensive  Care  Med.  2020;46(5):  846-8.  DOI:  10.1007/s00134-020-05991-x.

[25] Leonardo Italia, Daniela Tomasoni, Stefano Bisegna, Edoardo  Pancald.  COVID-19  and  heart  failure:  From epidemiology  during  the  pandemic  to  myocardial  injury, myocarditis, and heart failure sequelae. Front. Cardiovasc. 2021;8: 1-14.

[26] Maarten   Criel,   Maarten   Falter,   Jasmien Jaeken.   Venous   thromboembolism   in   SARS-CoV-2 patients:  only  a  problem  in  ventilated  ICU  patients,  or is  there  more  to  it.  Eur  Respir.  2020;56(1):  2001201. DOI: 10.1183/13993003.01201-2020

[27] Florian   Bompard,   Hippolyte   Monnier,   Ines Saab.  Pulmonary  embolism  in  patients  with  COVID-19 pneumonia.   Eur.   Respir.   J.   2020;56(1):   2001365. DOI: 10.1183/13993003.01365-2020

[28] Marisa  Dolhnikoff,  Amaro  Nunes  Duarte-Neto, Renata  Aparecida  de  Almeida  Monteiro.  Pathological evidence  of  pulmonary  thrombotic  phenomena  in  severe COVID-19. J Thromb Haemost. 2020;18(6): 1517-9.

[29] Gian Battista Danzi, Marco Loffi, Gianluca Galeazzi. Acute pulmonary embolism and COVID-19 pneumonia: a random association? Eur Heart J. 2020;41(19): 1858

[30] Julien  Poissy,  Julien  Goutay,  Morgan  Caplan. Pulmonary embolism in patients with COVID-19: Awareness of an increased prevalence. Circulation.2020;142(2): 184-6.

[31] Waqas  Ullah,  Rehan  Saeed,  Usman  Sarwar. COVID-19 Complicated by acute pulmonary embolism and right-sided heart failure. JACC Case Rep. 2020; 2(9): 1379-82.

[32] Jean M. Connors, Jerrold H. Levy. COVID-19 and its  implications  for  thrombosis  and  anticoagulation.  The American Society of Hematology. 2020;135(23): 2033-40.

[33] Richard  C  Becker.  COVID-19  update:  Covid-19-associated  coagulopathy.  J  Thromb  Thrombolysis. 2020;50(1): 54-67.

[34] Zsuzsanna Varga, Andreas J Flammer, Peter Steiger. Endothelial  cell  infection  and  endotheliitis  in  COVID-19. Lancet. 2020;395(10234): 1417-8.

[35] Maximilian  Ackermann,  Stijn  E  Verleden,  Mark Kuehnel.  Pulmonary  vascular  endothelialitis,  thrombosis, and angiogenesis in Covid-19. N Engl J Med. 2020;383(2): 120-8.

[36] Neal M. Dixit, Austin Churchill & Ali Nsair. Post-acute COVID-19 syndrome and the cardiovascular system: What is known? Am Heart J Plus. 2021;5: 100025.

[37] Swapna  Mandal,  Joseph  Barnett,  Simon  E  Brill. Long-COVID:  A  cross-sectional  study  of  persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19. Thorax. 2020;76(4): 396-8.

[38] Rita Rubin. As their numbers grow, COVID-19 “Long Haulers” Stump Experts. JAMA. 2020;324(14): 1381-83.

[39] Manuel Taboada, Esther Moreno, Agustín Cariñena. Quality of life, functional status, and persistent symptoms after  intensive  care  of  COVID-19  patient.  Br  J  Anaesth. 2021;126(3): e110-3.

[40] Maria  Vincenza  Polito,  Angelo  Silverio,  Michele Bellino.  Cardiovascular  involvement  in  COVID-19:  What sequelae should we expect. Cardiol Ther. 2021;10(2): 377-396.

[41] Mei Zhou, Zhengrong Yin, Juanjuan Xu. Inflammatory profiles and clinical features of Coronavirus 2019 survivors 3  months  after  discharge  in  Wuhan,  China.  J  Infect  Dis. 2021;224(9): 1473-88.

[42] Hisashi   Kai,   Mamiko   Kai.   Interactions   of coronaviruses with ACE2, angiotensin II, and RAS inhibitors –  xlessons  from  available  evidence  and  insights  into COVID-19.Hypertension Research volume. 2020;43: 648-54.

[43] Markus  Hoffmann,  Hannah  Kleine-Weber,  Simon Schroeder. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181(2): 271-80.

[44] Malvinder S. Parmar. An equally important protease as  ACE2  in  the  pathogenicity  of  SARS-CoV-2  infection. Mayo Clin Proc. 2020;96(11): 2748-52.

[45] Madeleine Johansson, Marcus Stahlberg, Michael Runold. Long-haul post-COVID-19 symptoms presenting as a variant of postural orthostatic tachycardia syndrome: The Swedish experience. JACC Case Rep. 2021;3(4): 573-80.

[46] Qiutang Xiong, Ming Xu, Jiao Li. Clinical sequelae of  COVID-19  survivors  in  Wuhan,  China:  a  single-centre longitudinal study. Clin Microbiol Infect. 2021;27(1): 89-95.

[47] Meredith Bryarly, Lauren T Phillips, Qi Fu. Postural orthostatic tachycardia syndrome: JACC Focus Seminar. J Am Coll Cardiol. 2019;73(10): 1207-28

[48] Fedorowski  A.  Postural  orthostatic  tachycardia syndrome: clinical presentation, aetiology and management. J Intern Med. 2019;285(4): 352-66.

[49] David  S  Goldstein.  The  possible  association between  COVID-19  and  postural  tachycardia  syndrome. Heart Rhythm. 2021;18(4): 508-9.

[50] Khalil Kanjwal, Sameer Jamal, Asim Kichloo. New-onset postural orthostatic tachycardia syndrome following coronavirus disease 2019 infection. J Innov Card Rhythm Manag. 2020;11(11): 4302-4.