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Review
. 2021 May 13;23(7):37.
doi: 10.1007/s11883-021-00935-2.

COVID and Cardiovascular Disease: What We Know in 2021

Michael Chilazi  1 , Eamon Y Duffy  1 , Aarti Thakkar  1 , Erin D Michos  2   3   4   5
Affiliations
Review

COVID and Cardiovascular Disease: What We Know in 2021

Michael Chilazi et al. Curr Atheroscler Rep. .

Abstract

Purpose of review: Coronavirus disease 2019 (COVID-19) has been the cause of significant global morbidity and mortality. Here, we review the literature to date of the short-term and long-term consequences of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection on the heart.

Recent findings: Early case reports described a spectrum of cardiovascular manifestations of COVID-19, including myocarditis, stress cardiomyopathy, myocardial infarction, and arrhythmia. However, in most cases, myocardial injury in COVID-19 appears to be predominantly mediated by the severity of critical illness rather than direct injury to myocardium from viral particles. While cardiac magnetic resonance imaging remains a powerful tool for diagnosing acute myocarditis, it should be used judiciously in light of low baseline prevalence of myocarditis. Guiding an athletic patient through return to play (RTP) after COVID-19 infection is a challenging process. More recent data show RTP has been a safe endeavor using a screening protocol. "Long COVID" or post-acute sequelae of SARS-CoV-2 infection has also been described. The reported symptoms span a large breadth of cardiopulmonary and neurologic complaints including fatigue, palpitations, chest pain, breathlessness, brain fog, and dysautonomia including postural tachycardia syndrome (POTS). Management of POTS/dysautonomia primarily centers on education, exercise, and salt and fluid repletion. Our understanding of the impact of COVID-19 on the cardiovascular system is constantly evolving. As we enter a new age of survivorship, additional research is needed to catalogue the burden of persistent cardiopulmonary symptoms. Research is also needed to learn how acute management may alter the likelihood and prevalence of this chronic syndrome.

Keywords: COVID-19; Cardiovascular disease; Long COVID; Return to play; SARS-CoV2.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Symbolic pie chart illustrating common causes of indirect myocardial injury and more rare causes of direct myocardial injury in COVID-19 infection
Fig. 2
Fig. 2
Review of the role and indications for cardiac magnetic resonance (CMR) imaging in acute and resolved infection, both in the general population and more specifically in athletes. Abbreviations: LV left ventricular, ACS acute coronary syndrome, CCTA coronary computed tomography angiography, TTE transthoracic echocardiography, EKG electrocardiogram
Fig. 3
Fig. 3
Review of the prevalence of long COVID, definitions and symptomatic manifestations, and current principles of management for potential COVID/postural orthostatic tachycardia syndrome overlap
Fig. 4
Fig. 4
Suggestions for future areas of investigation in the domains explored in this review. Abbreviations: POTS postural orthostatic tachycardia syndrome, CMR cardiac magnetic resonance
See this image and copyright information in PMC

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