Cardiology Department, Sismanoglio General Hospital of Attica, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Artificial Kidney Unit, General Hospital of Messinia, Kalamata, Greece.
Cardiovasc Drugs Ther. 2024 Oct;38(5):1017-1032. doi: 10.1007/s10557-023-07465-w. Epub 2023 May 20.
The risk of cardiovascular complications due to SARS-CoV-2 are significantly increased within the first 6 months of the infection. Patients with COVID-19 have an increased risk of death, and there is evidence that many may experience a wide range of post-acute cardiovascular complications. Our work aims to provide an update on current clinical aspects of diagnosis and treatment of cardiovascular manifestations during acute and long-term COVID-19.
SARS-CoV-2 has been shown to be associated with increased incidence of cardiovascular complications such as myocardial injury, heart failure, and dysrhythmias, as well as coagulation abnormalities not only during the acute phase but also beyond the first 30 days of the infection, associated with high mortality and poor outcomes. Cardiovascular complications during long-COVID-19 were found regardless of comorbidities such as age, hypertension, and diabetes; nevertheless, these populations remain at high risk for the worst outcomes during post-acute COVID-19. Emphasis should be given to the management of these patients. Treatment with low-dose oral propranolol, a beta blocker, for heart rate management may be considered, since it was found to significantly attenuate tachycardia and improve symptoms in postural tachycardia syndrome, while for patients on ACE inhibitors or angiotensin-receptor blockers (ARBs), under no circumstances should these medications be withdrawn. In addition, in patients at high risk after hospitalization due to COVID-19, thromboprophylaxis with rivaroxaban 10 mg/day for 35 days improved clinical outcomes compared with no extended thromboprophylaxis. In this work we provide a comprehensive review on acute and post-acute COVID-19 cardiovascular complications, symptomatology, and pathophysiology mechanisms. We also discuss therapeutic strategies for these patients during acute and long-term care and highlight populations at risk. Our findings suggest that older patients with risk factors such as hypertension, diabetes, and medical history of vascular disease have worse outcomes during acute SARS-CoV-2 infection and are more likely to develop cardiovascular complications during long-COVID-19.
感染 SARS-CoV-2 后最初 6 个月内发生心血管并发症的风险显著增加。COVID-19 患者死亡风险增加，有证据表明许多患者可能会经历广泛的急性后心血管并发症。我们的工作旨在提供当前关于急性和长期 COVID-19 期间心血管表现的诊断和治疗的临床方面的最新信息。
SARS-CoV-2 已被证明与心血管并发症的发生率增加有关，例如心肌损伤、心力衰竭和心律失常，以及凝血异常，不仅在急性期，而且在感染后的 30 天内，与高死亡率和不良预后有关。在长 COVID-19 期间发现了心血管并发症，无论年龄、高血压和糖尿病等合并症如何；然而，这些人群在急性后 COVID-19 期间仍然面临最坏结局的高风险。应重视这些患者的管理。对于心率管理，可考虑使用低剂量口服普萘洛尔（一种β受体阻滞剂）进行治疗，因为它被发现可显著减轻心动过速并改善体位性心动过速综合征的症状，而对于正在服用 ACE 抑制剂或血管紧张素受体阻滞剂（ARB）的患者，无论如何都不应停药。此外，在因 COVID-19 住院后风险较高的患者中，与无延长的血栓预防相比，每日使用利伐沙班 10mg 进行 35 天的血栓预防可改善临床结局。在这项工作中，我们全面综述了急性和急性后 COVID-19 心血管并发症、症状和病理生理学机制。我们还讨论了这些患者在急性和长期护理期间的治疗策略，并强调了高危人群。我们的研究结果表明，患有高血压、糖尿病和血管疾病病史等危险因素的老年患者在急性 SARS-CoV-2 感染期间预后较差，并且在长 COVID-19 期间更有可能发生心血管并发症。
