Cardiovascular Considerations in the Management of People With Suspected Long COVID

Research Summary:

Research Focus: The research focuses on investigating long COVID, particularly the cardiovascular symptoms and functional limitations associated with the condition.
Methodology: A rapid evidence review was conducted with the assistance of a trained librarian, utilizing the Ovid MEDLINE database to gather relevant articles.

Functional Limitations in Long COVID:
- Exercise intolerance and PEM/PESE can persist regardless of acute illness severity.
- Research needed to differentiate specific functional limitations from critical illness effects.
Cardiovascular Symptoms in Long COVID:
- Dysautonomia with cardiac manifestations like IST and POTS is common.
- Clinicians should be aware to avoid misdiagnosis and dismissals.
Assessment of Long-term Cardiovascular Symptoms:
- Recommended algorithm for assessing cardiovascular symptoms post-SARS-CoV-2 infection.
- Biomarkers alone may not be sufficient triggers for further cardiac investigations.
Management of Cardiac Sequelae in Long COVID:
- Review of global evidence and Canadian expert opinions on diagnosing and treating cardiac symptoms in long COVID patients.

Recommendations in testing:

Adopt WHO Definition: Use the World Health Organization definition of post-COVID condition/long COVID instead of the CDC definition.

Acknowledge Uncertainty: Recognize uncertainty as a potential bias source that could lead to overinvestigation and misleading findings.
Shared Decision-Making: Involve shared decision-making between the patient and clinician in the testing process.
Screening for Symptoms: Screen for signs of PEM/PESE, myalgic encephalomyelitis/chronic fatigue syndrome, and dysautonomia with cardiac manifestations.
Physical Examination: Conduct a detailed physical examination including resting vital signs for hypertension, orthostatic vital signs, and a 10-minute stand test for POTS and related disorders.
Initial Investigations: Perform a limited set of initial investigations including complete blood count, electrolytes, creatinine, random blood glucose, hemoglobin A1c, thyroid stimulating hormone, and a resting ECG to identify specific signs of ischemia, arrhythmia, and myopericarditis.
Consider Fragmented QRS: Consider the development of a fragmented QRS as a potential independent risk factor for POTS and IST.

Main Points:

Key Findings:

Functional limitations such as exercise intolerance and post-exertional malaise (PEM)can persist in long COVID patients.
Cardiovascular symptoms like dysautonomia with manifestations such as inappropriate sinus tachycardia (IST) and postural orthostatic tachycardia syndrome (POTS) are common.
Recommendations were made for the assessment and management of long-term cardiovascular symptoms post-SARS-CoV-2 infection, emphasizing the importance of a thorough evaluation and avoiding overinvestigation.
The research integrates expert opinions and the latest evidence to provide guidance on diagnosing and treating cardiac sequelae in long COVID patients.

Functional limitations and cardiovascular symptoms in long COVID underscore the need for comprehensive assessment and tailored management strategies to address the persistent health challenges faced by affected individuals.
Long Covid The Answers

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