Preprint: Characteristics of Patients Referred to a Cardiovascular Disease Clinic for Post-Acute Sequelae of SARS-CoV-2 Infection, 2021, Wang et al

ABSTRACT

There is limited literature on the cardiovascular manifestations of post-acute sequelae of SARS-CoV-2 infection (PASC). We aimed to describe the characteristics, diagnostic evaluations, and cardiac diagnoses in patients referred to a cardiovascular disease clinic designed for patients with PASC from May 2020 to September 2021.

Of 126 patients, average age was 46 years (range 19-81 years), 43 (34%) were male. Patients presented on average five months after COVID-19 diagnosis. 30 (24%) patients were hospitalized for acute COVID-19. Severity of acute COVID-19 was mild in 37%, moderate in 41%, severe in 11%, and critical in 9%. Patients were also followed for PASC by pulmonology (53%), neurology (33%), otolaryngology (11%), and rheumatology (7%).

Forty-three patients (34%) did not have significant comorbidities. The most common symptoms were dyspnea (52%), chest pain/pressure (48%), palpitations (44%), and fatigue (42%), commonly associated with exertion or exercise intolerance. The following cardiovascular diagnoses were identified: nonischemic cardiomyopathy (5%); new ischemia (3%); coronary vasospasm (2%); new atrial fibrillation (2%), new supraventricular tachycardia (2%); myocardial involvement (15%) by cardiac MRI, characterized by late gadolinium enhancement (LGE; 60%) or inflammation (48%).

The remaining 97 patients (77%) exhibited common symptoms of fatigue, dyspnea on exertion, tachycardia, or chest pain, which we termed “cardiovascular PASC syndrome.” Three of these people met criteria for postural orthostatic tachycardia syndrome. Lower severity of acute COVID-19 was a significant predictor of cardiovascular PASC syndrome. In this cohort of patients referred to cardiology for PASC, 23% had a new diagnosis, but most displayed a pattern of symptoms associated with exercise intolerance.

Open access: https://www.medrxiv.org/content/10.1101/2021.12.04.21267294v1

 

It's a bit better than average but it's really important that they clue in that it's exertion intolerance, not exercise. It's not about going for a 5km jog and being more winded than usual after. There's still a serious lack of depth of understanding. It's mentioned as an or but that's not good enough, this is probably the biggest obstacle for most physicians, they just don't understand the depth of how little exertion it takes and how disproportionately punishing it is.

Big issue also in only considering POTS, missing out that most dysautonomia does not meet POTS criteria.

Still the pace of understanding is far too low, most of this was easy to figure out right from the start. It was never a problem of technology, it's a problem of seeing the problem for what it is, both without the prejudices of the past and acknowledging how those prejudices led to failure.

 

Now published.

Abstract

Introduction
There is limited literature on cardiovascular manifestations of post-acute sequelae of SARS-CoV-2 infection (PASC).

Methods
This observational study aimed to describe the characteristics, diagnostic evaluations, and new cardiac diagnoses in patients referred to a cardiovascular disease clinic designed for patients with PASC, and to identify factors associated with cardiovascular symptoms with no identifiable cardiac pathology.

Results
Of 126 patients, average age was 46 years, and 34 % were male. Patients presented on average five months after COVID-19 diagnosis. The most common symptoms were dyspnea (52 %), chest pain/pressure (48 %), palpitations (44 %), and fatigue (42 %), commonly associated with exertion or exercise intolerance. New cardiovascular diseases were present in 23 % of cases. The remainder exhibited common symptoms which we termed “cardiovascular PASC syndrome.”

Discussion
We found that only one in four patients had a new cardiovascular diagnosis, but most displayed a pattern of symptoms associated with exercise intolerance.

Open access, https://www.sciencedirect.com/science/article/pii/S2666602222000933