A paper from the American College of Cardiology
Many are the aftermath of Covid-19 especially on the heart: chest pain, palpitations and changes in the heartbeat but also fatigue and breathing difficulties are a problem for 10-30% of infected patients, even 4 or more months after the resolution of the infection. There is a long cardiovascular-only Covid which is now classified by experts with the term PASC (Post Acute Sequelae from SARS-Cov-2, sequelae after a SARS-CoV-2 infection). To manage these patients in the most appropriate way, the American College of Cardiology has just published in the Journal of the American College of Cardiology, a consensus document that indicates the way to go to address long Covid when, as often happens, it involves the heart and vases. The document should become a guide to be followed even on this side of the ocean: the experts of the Italian Society of Cardiology (SIC)calling attention to the opportunity to undergo a correct diagnostic procedure in the presence of cardiovascular symptoms after Covid and also the importance of using the correct physical activity as an effective method to get back to being healthy.
“Cardiovascular long Covid is now identified as PASC (Post-Acute Sequelae from SARS-Cov-2): there are so many cases of patients with cardiovascular involvement after acute infection that a new disease has been defined – points out Ciro Indolfi, SIC president and Full Professor of Cardiology at the Magna Graecia University of Catanzaro – We speak of PASC-CVD when after the diagnostic tests a real cardiovascular disease is identified, or of PASC-CVS or cardiovascular PASC syndrome when instead the standard diagnostic tests have not identified a specific cardiovascular disease but typical symptoms such as tachycardia are present, exercise intolerance, chest pain and shortness of breath. Unfortunately, there seems to be a ‘downward spiral’ in long Covid, as our American colleagues have defined it: fatigue and reduced ability to exercise lead to a decrease in activity and bed rest, which in turn lead to a worsening of symptoms and a reduced quality of life“. The new US consensus document recommends a baseline cardiopulmonary assessment done in advance to determine if additional specialist care and medical therapy is needed for these patients: the initial approach to symptoms should include basic laboratory tests, including troponin heart rate, an electrocardiogram, an echocardiogram, an outpatient rhythm monitor, chest imaging, and / or pulmonary function tests. “Cardiac counseling is recommended for patients with PASC and abnormal cardiac test results, in those with known cardiovascular disease with new or worsening symptoms, if the patient has had documented heart complications during SARS CoV-2 infection, and / or persistent cardiopulmonary symptoms that are not otherwise explained – resumes Indolfi – In the presence of the PASC syndrome, in which therefore there is no cardiological disease but there are symptoms such as tachycardia, exercise intolerance and / or deconditioning, or a reduction in training capacity compared to before the infection, it is initially recommended the exercise in a recumbent or semi-recumbent position, such as cycling, swimming, or rowing, and then move on to exercise also in standing position as your ability to stand without breathlessness improves. Exercise duration should also be short initially (5 to 10 minutes per day), with gradual increases as functional capacity improves. In the PASC syndrome, the intake of salt and liquids may also be useful, to reduce symptoms such as tachycardia, palpitations and / or orthostatic hypotension; in some cases the doctor may prescribe beta-blockers, non-dihydropyridine calcium channel blockers, ivabradine, fludrocortisone and midodrine ”.
“We need to know more from further follow up studies but the important – conclude Pasquale Perrone Filardi, SIC elected president and Full Professor of Cardiology at the Federico II University of Naples – is not to neglect cardiovascular signs and symptoms that appear and / or persist 4 or more weeks after recovery from Covid-19: the virus has negative effects on the heart and vessels and it is essential to immediately identify any cardiovascular ‘suffering’ in order to intervene at better”.