A Study on Cardiac Sequelae After COVID-19 Recovery

Srabani Roy Chowdhury, MAKAUT- West Bengal

We all know that COVID-19 principally affects the respiratory system. But recent reports state that both SARS-CoV-2 recovered and active patients show extra-pulmonary manifestations, which can be cardiovascular, renal, gastrointestinal and, neurological. The interaction between SARS-CoV-2 with the cardiovascular system is not much recognized yet. But studies show that it causes heart damage indirectly by inducing cytokine storm and hypoxia in individuals with severe COVID-19 complications and hypoxia in individuals with severe COVID-19 complications. Myocardial or pericardial inflammation, arrhythmia, heart failure and, sudden cardiac death can be observed in the pre-recovery phase with an increase in severity of the disease.

Study Records:

Different cases were studied for this study. It comprised of retrospective, prospective and cross-sectional studies along with case series and reports that described any type of cardiac assessment that COVID-19 recovered adult patients went through. COVID-19 recovery depends on:

• Asymptomatic or mild symptoms 2weeks after the primary diagnosis of SARS-CoV-2 infection
• moderate symptoms 3weeks after the primary diagnosis of SARS-CoV-2 infection
• severe symptoms (with or without hospitalization) patients post-discharge.

CMR imaging assessment studies reported pericardial effusion, decreased global longitudinal strain, decreased left ventricular ejection fraction, myocardial and pericardial enhancement, and increased extracellular volume. Cardiac assessment with echocardiogram studies also revealed similar cases, along with left ventricular hypertrophy, diastolic dysfunction, and pulmonary hypertension for most of the individuals. T-wave changes, sinus tachycardia, and right bundle branch block observed in ECG assessments.

Troponin level assessment and NT-pro-BNP level assessment revealed an increased level, only in few individuals. Studies with CMR or ECG mostly showed changes in patients after a recovery period of 3 months. But the echocardiogram and NT-pro-BNP level assessment showed changes in patients with a post-recovery period of 3 to 6 months. Studies that reported individuals with coronary angiogram showed two-vessel coronary artery disease with left anterior descending artery occlusion. Few studies also reported cardiac problems like chest pain, palpitations, and dyspnea in individuals with moderate COVID-19 symptoms. Adverse effects reported from the studies include heart failure, myocardial infarction, stroke, and arrhythmia. New-onset of major cardiovascular issues also found in some.

Significance of the study:

The studies demonstrate the risk of cardiac abnormalities found in individuals who have recovered from COVID-19.  Evidence shows that they are more prone to cardiac sequelae compared to individuals who never had any SARS-CoV-2 infection. Though the symptoms are mostly non-specific, hospitalized patients have a much higher chance of developing cardiac problems like myocardial infarction, arrhythmia, stroke, and heart failure after COVID-19 recovery.

Short-term cardiac problems like chest pain and palpitations might be a hint towards an active inflammation of the myocardium. It can be assessed by endomyocardial biopsy.  The SARS-CoV2 virus attaches itself to the ACE-2 (Angiotensin Converting Enzyme 2) receptor which is expressed abundantly in lungs, heart, and kidney cells. Thus the infecting virus provides a pathophysiological basis for cardiac injury because the direct damage through cell invasion develops increased inflammation and coagulation.

Conclusion:

COVID-19 causes structural and functional cardiac implications during or after recovery even with all the advancements in treatments. Present understanding of cardiac sequelae after COVID-19 recovery is not adequate. It can only be improved with further studies. However, it is evident from the recent studies that there is a lower risk of cardiac complications in patients with mild COVID-19 than those who had a much more severe impact.

Also read: J&J COVID-19 vaccine: A potential disaster for humans

Reference:

1. Ramadan, M. S., Bertolino, L., Zampino, R., Durante-Mangoni, E., Durante-Mangoni, E., Iossa, D., Bertolino, L., Ursi, M. P., D’Amico, F., Karruli, A., Ramadan, M., Andini, R., Zampino, R., Bernardo, M., Ruocco, G., Dialetto, G., Covino, F. E., Manduca, S., Della Corte, A., … Galdieri, N. (2021). Cardiac sequelae after coronavirus disease 2019 recovery: A systematic review. Clinical Microbiology and Infection, S1198743X21003359. https://doi.org/10.1016/j.cmi.2021.06.015

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