Long Covid becomes new heart disease, 'Pasc syndrome' is born
Pasc syndrome: chest pain, palpitations and heartbeat changes, but also fatigue and breathing difficulties affect 10-30% of infected patients, even 4 months or more after the infection has resolved
The effects of Covid-19 on the heart, in particular, are many: chest pain, palpitations and heartbeat changes, but also fatigue and breathing difficulties are a problem for 10-30% of infected patients, even 4 months or more after resolution of the infection.
There is a cardiovascular-only long covid that is now classified by experts under the term PASC (Post Acute Sequelae from SARS-Cov-2, sequelae after SARS-CoV-2 infection)
In order to manage these patients in the most appropriate way, the American College of Cardiology has just published in the Journal of the American College of Cardiology, a consensus document that points the way forward in dealing with Long Covid when, as is often the case, it involves the heart and vessels.
The document should become a guide to be followed even on this side of the ocean: this is stressed by the experts of the Italian Society of Cardiology (SIC), drawing attention to the advisability of undergoing a proper diagnostic procedure in the presence of cardiovascular symptoms after Covid and also the importance of using proper physical activity as an effective way to get back to feeling good.
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LONG COVID, THE SYMPTOMS OF PASC
Long Covid at cardiovascular level is now identified as PASC (Post-Acute Sequelae from SARS-Cov-2): there are so many cases of patients with cardiovascular involvement after the acute infection that a new disease has been defined.
One speaks of PASC-CVD when diagnostic tests identify a true cardiovascular disease, or of PASC-CVS or PASC cardiovascular syndrome when standard diagnostic tests have not identified a specific cardiovascular disease but typical symptoms such as tachycardia, exercise intolerance, chest pain and shortness of breath are present.
Unfortunately, there seems to be a ‘downward spiral’ in Long Covid, as American colleagues have called it: fatigue and reduced exercise capacity lead to decreased activity and bed rest, which in turn leads to worsening symptoms and reduced quality of life.
The new US consensus document recommends a basic cardiopulmonary assessment performed early to determine whether further specialist care and medical therapy is needed for these patients: the initial approach in case of symptoms should include basic laboratory tests, including cardiac troponin, an electrocardiogram, echocardiogram, ambulatory rhythm monitoring, chest imaging and/or pulmonary function tests.
Cardiology consultation is recommended for patients with PASC and abnormal cardiac test results, in those with known cardiovascular disease with new or worsening symptoms, if the patient has had documented cardiac complications during SARS CoV-2 infection and/or persistent cardiopulmonary symptoms that are not otherwise explained.
In the presence of PASC syndrome, in which there is therefore no cardiac disease but there are symptoms such as tachycardia, exercise intolerance and/or deconditioning, i.e. a reduction in exercise capacity compared with before infection, exercise in a lying or semi-recumbent position, such as cycling, swimming or rowing, is initially recommended and then exercise in an upright position as the ability to stand without breathlessness improves.
The duration of exercise should also be short initially (5 to 10 minutes per day), with gradual increases as functional capacity improves.
In PASC syndrome, the intake of salt and liquids may also be useful to reduce symptoms such as tachycardia, palpitations and/or orthostatic hypotension
In some cases, the doctor may prescribe beta-blockers, non-dipropyridine calcium channel blockers, ivabradine, fludrocortisone and midodrine.
We need to know more from further follow-up studies, but the important thing is not to overlook cardiovascular signs and symptoms that appear and/or persist 4 weeks or more after recovery from Covid-19: the virus has negative effects on the heart and vessels and it is essential to detect any cardiovascular ‘distress’ early on in order to take the best possible action.
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