Indolfi Ciro, Barillà Francesco, Basso Cristina, Ciccone Marco Matteo, Curcio Antonio, Gargiulo Paola, Nodari Savina, Mercuro Giuseppe, Mancone Massimo, Muscoli Saverio, Pedrinelli Roberto, Porcari Aldostefano, Spaccarotella Carmen, Romeo Francesco, Sinagra Gianfranco, Filardi Pasquale Perrone
Società Italiana di Cardiologia, Roma - Istituto di Cardiologia, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi "Magna Graecia", Catanzaro.
Società Italiana di Cardiologia, Roma - Dipartimento di Medicina dei Sistemi, Università degli Studi "Tor Vergata", Roma.
G Ital Cardiol (Rome). 2022 Jul;23(7):491-503. doi: 10.1714/3831.38166.
Although the clinical course of COVID-19 in its acute phase is now delineated, less known is its late phase characterized by a heterogeneous series of sequelae affecting various organs and systems, including the cardiovascular system, which continue after the acute episode or arise after their resolution. This syndrome, now referred with the new acronym "PASC" (post-acute sequelae of SARS-CoV-2 infection) has been formally recognized by various scientific societies and international organizations that have proposed various definitions. The World Health Organization defines PASC, distinguishing it from "ongoing symptomatic COVID-19", as a condition that arises few weeks after infection, persists at least 8 weeks, and cannot be explained by alternative diagnoses.There are multiple mechanisms responsible for PASC: inflammation, immune activation, viral persistence, activation of latent viruses, endothelial dysfunction, impaired response to exercise, and profound cardiac deconditioning following viral infection. The key symptoms of PASC are palpitations, effort dyspnea, chest pain, exercise intolerance, and postural orthostatic tachycardia syndrome.For PASC treatment, it may be useful to take salt and fluid loading, to reduce symptoms such as tachycardia, palpitations, and/or orthostatic hypotension, or in some subjects the use of drugs such as beta-blockers, non-dihydropyridine calcium channel blockers, ivabradine, and fludrocortisone.Finally, in PASC a gradual resumption of physical activity is recommended, starting with recumbent or semi-recumbent exercise, such as cycling, swimming, or rowing, and then moving on to exercise in an upright position such as running when the ability to stand improves without dyspnea appearance. Exercise duration should also be short initially (5 to 10 min per day), with gradual increases as functional capacity improves.
尽管目前已明确了新冠病毒疾病（COVID-19）急性期的临床病程，但对其后期阶段却知之甚少。后期阶段的特点是一系列影响各个器官和系统的后遗症，表现各异，包括心血管系统，这些后遗症在急性期过后仍会持续，或在急性期症状缓解后出现。这种综合征现在被简称为“PASC”（新冠病毒2感染的急性后遗症），已得到多个科学协会和国际组织的正式认可，它们提出了各种定义。世界卫生组织对PASC进行了定义，将其与“持续有症状的COVID-19”区分开来，指感染数周后出现、持续至少8周且无法用其他诊断解释的一种病症。导致PASC的机制有多种：炎症、免疫激活、病毒持续存在、潜伏病毒激活、内皮功能障碍、运动反应受损以及病毒感染后严重的心脏功能失调。PASC的关键症状有心悸、劳力性呼吸困难、胸痛、运动不耐受和体位性直立性心动过速综合征。对于PASC的治疗，补充盐分和液体可能有助于减轻心动过速、心悸和/或体位性低血压等症状，在某些患者中，使用β受体阻滞剂、非二氢吡啶类钙通道阻滞剂、伊伐布雷定和氟氢可的松等药物也可能有效。最后，对于PASC患者，建议逐渐恢复体力活动，开始时进行卧位或半卧位运动，如骑自行车、游泳或划船，然后在站立能力改善且无呼吸困难出现时，过渡到进行直立位运动，如跑步。运动持续时间最初也应较短（每天5至10分钟），随着功能能力的改善逐渐增加。
