Cardiovascular complications caused by SARS-COV2 infection, the higher risk of COVID-19 when there are chronic heart diseases and the sequelae that this disease can leave in the heart, make cardiology a medical specialty with relevant intervention with COVID patients -19, including after illness . COVID-19 risk Symptoms variability in people infected with SARS-CoV-2 is a characteristic of COVID-19 that was quickly identified after the disease was known, namely the relationship between the existence and severity of symptoms with age and the presence of other diseases (comorbidities), in particular chronic diseases. These include, for example: Coronary heart disease, heart failure, high blood pressure, cardiac arrhythmias and other cardiovascular diseases; Chronic respiratory failure; Obesity; Cancer. Cardiovascular complications and sequelae of COVID-19 About a year later, we have a better knowledge of COVID-19 symptoms, its evolution, and the possible complications of the disease, among which are cardiovascular complications . The leading cause of death in patients with COVID-19 is respiratory failure. However, cardiac disorders contribute to the overall mortality and may even be the leading cause of death in COVID-19 patients. Cardiac complications are reported in 8% -15% of infected patients and in higher percentages in fatality cases of COVID-19. In COVID-19 patients, both pre-existing heart disease can worsen and new cardiopathies can develop. Some medications that can be used to treat COVID-19 can also increase the overall cardiovascular risk. The possible cardiovascular complications in COVID-19 patients do not have a single cause . They are due both to the direct effects of the viral load on heart cells, as well as to indirect effects resulting from the immune and inflammatory response to the infection. The main cardiac complications that have been described are: Acute myocarditis , seen in 7% -17% of hospitalized patients, figures that increases to around 22% in patients who need intensive care and to 59% in deceased patients. Heart failure and cardiogenic shock, identified in more than 50% of deceased patients and in approximately 12% of recovered ones. Acute coronary syndromes , for example myocardial infarctions in the context of increased blood coagulability typical of COVID-19 and due to rupture of non-obstructive coronary plaques (present in 33% of patients). Arrhythmias , more common also in intensive care patients. We also know that COVID-19 can leave sequelae not just in people who needed intensive care or other hospital care, in different body systems, namely cardiovascular . However, we still know little about the evolution of these sequelae and its long-term effects. Cardiac involvement, even if mild, has been identified in a significant number of COVID-19 recovered patients, regardless of pre-existing illnesses and the severity and course of previous SARS-CoV-2 infection. In view of cardiac sequelae, it is prudent that the return to daily activities, particularly the practice of physical activity, is be made with medical advice. Follow-up after COVID-19 Many COVID-19 recovered patients have been doing and benefited from medical follow-up and rehabilitation after the illness . This follow-up is now carried out according to specific protocols , involves several medical specialties and other health professionals, and intends to identify sequelae of the disease that need rehabilitation to achieve a full recovery . In the area cardiology, there is still much to know about the long-term effects of COVID-19. Depending on the circumstances, in addition to regular medical follow-up, for as long as necessary, specific cardiology protocols after SARS-CoV2 infection may need fundamental diagnostic tests, among which the following stand out: Echocardiography M-2D and Doppler; 24-hour dynamic ECG (Holter); Exercise stress test. The high rate of cardiac involvement in COVID-19 makes it essential the patients follow-up after the disease, either to follow complications that have occurred or to detect sequelae and thus intervene to prevent late complications. Author: Nuno Cardim References American College of Cardiology. Current key questions on COVID-19 and cardiovascular disease . Março, 2021. Dhakal BP, Sweitzer NK, Indik JH, Acharya D, William P. SARS-CoV-2 infection and cardiovascular disease: COVID-19 heart . Heart Lung Circ 2020;29:973-87. Puntmann VO, Carerj ML, Wieters I, Fahim M, Arendt C, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19) . JAMA Cardiol 2020;5:1265-73. Meet the cardiology team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
