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Review
. 2022 Mar 28:40:101012.
doi: 10.1016/j.ijcha.2022.101012. eCollection 2022 Jun.

Cardiovascular complications in the Post-Acute COVID-19 syndrome (PACS)

Sheref A Elseidy  1 , Ahmed K Awad  2 , Monica Vorla  3 , Amina Fatima  4 , Merihan A Elbadawy  2 , Debvarsha Mandal  4 , Tamam Mohamad  5
Affiliations
Review

Cardiovascular complications in the Post-Acute COVID-19 syndrome (PACS)

Sheref A Elseidy et al. Int J Cardiol Heart Vasc. .

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) or coronavirus disease 2019 (COVID-19) initially surfaced in December 2019 from Wuhan, China, sweeping the world with various strains, forcing the WHO to declare a pandemic epidemic in March 2020. Furthermore, COVID-19 manifests with a wide array of presentations from fever and fatigue to severe respiratory and cardiovascular complications. Post-COVID-19 syndrome is poorly understood affecting COVID-19 survivors at all levels of disease severity. The disease is most associated with post-discharge dyspnea and fatigue. However, other persistent symptoms as chest pains, palpitations, smell, and taste dysfunctions. Patients with high concentrations of CRP and creatinine in the acute phase of Covid-19 are more prone to cardiac sequelae. Therefore, high levels of cardiac-sensitive troponin and hypokalaemia can also be used for risk stratification. Furthermore, Cardiac damage can manifest as myocarditis, pericarditis, rhythm abnormalities. The use of different diagnostic modalities like electrocardiogram (ECG), echocardiogram, and cardiac magnetic resonance imaging (MRI)(CMR) to evaluate the myocardial damage were studied. However, Cardiovascular complications are a common manifestation of PASC, classification of severity of cardiac symptoms and the emergence of CMR as a diagnostic tool needs more evidence.

Keywords: ACE2, Angiotensin-converting enzyme 2; CAMKII, calmodulin-dependent protein kinase II; CMR, Cardiac magnetic resonance imaging; COVID-19; COVID-19, Coronavirus disease 2019; CVD, Cardiovascular disease; Cardiovascular diseases; DAMPs, damage-associated molecular patterns; IL, interleukin; Myocardial infarction; NOAC, novel oral anticoagulation; PACS, Post-Acute COVID-19 syndrome; Post covid sequelae; RAAS, Renin-Angiotensin Aldosterone System dysregulation; SARS-CoV 2, severe acute respiratory syndrome coronavirus 2; TMPRS2, transmembrane protease serine 2; TNF-Alpha, Tumor necrosis factor-alpha; TTE, transthoracic echocardiogram; UFH, Unfractionated heparin; VTE, venous thromboembolism; WHO, World health organization.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Post-acute COVID-19 syndrome: An overview and approach to classification.
Fig. 2
Fig. 2
RAAS pathway regulation and its cardio-specific effects.
Fig. 3
Fig. 3
The pathophysiological mechanisms of cardiac involvement in Acute COVID-19 and post-acute COVID-19 syndrome.
See this image and copyright information in PMC

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