The negative effects of long COVID-19 on cardiovascular health and implications for the presurgical examination.

IF 1.4 Q2 MEDICINE, GENERAL & INTERNAL Journal of Osteopathic Medicine Pub Date : 2024-10-17 DOI:10.1515/jom-2024-0109
Hannah L Stimart, Brittany Hipkins
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Abstract

Context: In 2019, emergence of the novel and communicable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection took scientific communities by surprise and imposed significant burden on healthcare systems globally. Although the advent of this disease piqued the interest of academic centers, healthcare systems, and the general public, there is still much yet to be elucidated regarding epidemiology, pathophysiology, and long-term impacts of coronavirus disease 2019 (COVID-19). It has been established that long COVID-19 can impact multiple organ systems, including the cardiovascular system, unfavorably. Although the pathophysiology of this damage is not well understood, adverse sequelae may range from chest pain and arrhythmias to heart failure (HF), myocardial infarction, or sudden cardiac death. For any postacute COVID-19 patient requiring a surgical procedure, the potential for cardiac injury secondary to long COVID-19 must be considered in the preoperative cardiac examination.

Objectives: This literature review serves to add to the growing body of literature exploring postacute cardiovascular outcomes of COVID-19, with a focus on presurgical cardiac clearance in the adult patient. Specifically, this review studies the prevalence of cardiovascular symptomatology including chest pain, arrhythmias, blood pressure changes, myo-/pericarditis, HF, cardiomyopathy, orthostatic intolerance, and thromboembolism. Although current evidence is scarce in both quality and quantity, it is the goal that this review will highlight the negative impacts of long COVID-19 on cardiovascular health and encourage providers to be cognizant of potential sequelae in the context of the presurgical examination.

Methods: For this study, peer-reviewed and journal-published articles were selected based on established inclusion and exclusion criteria to address the question "How does long COVID-19 impact the presurgical cardiac examination of an adult scheduled to undergo a noncardiac procedure?" Inclusion criteria included human studies conducted in adult patients and published in peer-reviewed journals up until May 2024 examining the effects of long-COVID-19 infection on the cardiovascular system. Exclusion criteria eliminated unpublished reports, preprints, duplicate articles, literature regarding coronavirus strains other than COVID-19, studies regarding post-COVID-19 vaccination complications, animal studies, and studies conducted in people younger than 18 years of age. A total of 6,675 studies were retrieved from PubMed and Google Scholar. Following screening, 60 studies were included in final consideration.

Results: Cardiovascular symptoms of postacute COVID-19 infection were encountered with the following percentages prevalence (total numbers of articles mentioning symptom/total number of articles [60]): chest pain (83.3), arrhythmias (88.3), hypertension (40.0), hypotension (16.7), myocarditis (80.0), pericarditis (51.7), HF (70.0), cardiomyopathy (55.0), orthostatic intolerance (56.7), and thromboembolic events (85.0).

Conclusions: The presence of persisting COVID symptoms may negatively impact the patient's physical examination, blood tests, electrocardiogram (ECG), imaging, and/or echocardiogram. Cardiac conditions associated with long COVID require special attention in the context of the presurgical candidate due to an increased risk of sudden cardiac death, myocarditis, stroke, and myocardial infarction - even in those who were healthy prior to acute COVID-19 infection. Until more specific scientific evidence comes to light, care of these patients should be viewed through the prism of the best practices already in use and clinicians should maintain a low threshold to pursue more extensive cardiac workup prior to surgery.

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长 COVID-19 对心血管健康的负面影响及对手术前检查的影响。
背景:2019 年,新型传染性严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)感染的出现令科学界措手不及,并给全球医疗保健系统带来了沉重负担。尽管这种疾病的出现引起了学术中心、医疗保健系统和公众的兴趣,但关于冠状病毒病 2019(COVID-19)的流行病学、病理生理学和长期影响,仍有许多问题有待阐明。已经证实,长期的 COVID-19 会对包括心血管系统在内的多个器官系统产生不利影响。虽然这种损害的病理生理学尚不十分清楚,但不良后遗症的范围可能从胸痛和心律失常到心力衰竭(HF)、心肌梗塞或心脏性猝死。对于任何需要进行外科手术的急性 COVID-19 后患者,在术前心脏检查中必须考虑长 COVID-19 继发心脏损伤的可能性:本文献综述旨在补充日益增多的探讨 COVID-19 急性期后心血管后果的文献,重点关注成年患者的术前心脏检查。具体而言,本综述研究了心血管症状的发生率,包括胸痛、心律失常、血压变化、心肌炎/心包炎、心房颤动、心肌病、正压性不耐受和血栓栓塞。虽然目前的证据在质量和数量上都很匮乏,但本综述旨在强调长期 COVID-19 对心血管健康的负面影响,并鼓励医疗服务提供者在术前检查时认识到潜在的后遗症:本研究根据既定的纳入和排除标准选择同行评审和期刊发表的文章,以解决 "长 COVID-19 对计划接受非心脏手术的成人的术前心脏检查有何影响?纳入标准包括截至 2024 年 5 月在同行评审期刊上发表的、针对成人患者进行的人类研究,这些研究探讨了长 COVID-19 感染对心血管系统的影响。排除标准包括未发表的报告、预印本、重复文章、有关 COVID-19 以外冠状病毒毒株的文献、有关接种 COVID-19 疫苗后并发症的研究、动物研究以及在 18 岁以下人群中开展的研究。从 PubMed 和 Google Scholar 共检索到 6675 项研究。经过筛选,60 项研究被纳入最终考虑范围:结果:急性 COVID-19 感染后出现的心血管症状的比例如下(提及症状的文章总数/文章总数 [60]):胸痛(83.3)、心律失常(88.3)、高血压(40.0)、低血压(16.7)、心肌炎(80.0)、心包炎(51.7)、HF(70.0)、心肌病(55.0)、正压性不耐受(56.7)和血栓栓塞事件(85.0):持续的 COVID 症状可能会对患者的体格检查、血液化验、心电图 (ECG)、影像学检查和/或超声心动图检查产生负面影响。由于心脏性猝死、心肌炎、中风和心肌梗死的风险增加,即使在急性 COVID-19 感染前身体健康的人也会出现此类风险,因此与长期 COVID 相关的心脏疾病需要手术前候选人特别注意。在获得更多具体的科学证据之前,应根据已采用的最佳实践对这些患者进行护理,临床医生应保持较低的门槛,在手术前进行更广泛的心脏检查。
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来源期刊
Journal of Osteopathic Medicine
Journal of Osteopathic Medicine Health Professions-Complementary and Manual Therapy
CiteScore
2.20
自引率
13.30%
发文量
118
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