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New expert clinical guidance issued on cardiovascular consequences of COVID-19

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The American College of Obstetrics and Gynecology offers an expert decision-making process for evaluating and managing adults with significant coronary heart disease COVID-19. The paper discusses the subject of myocarditis and other types of coronary heart disease, patient-centered approaches to long-term COVID and a guide to recovery from exercise after COVID-19. The hospital guide is published today in Journal of the American Academy of Cardiology.

“The best way to diagnose and treat myocarditis and long-term COVID after infection with SARS-CoV-2 infection continues to improve, “said Ty Gluckman, MD, MHA, president of the decision-making team. safe return to play for active and non-competitive players ”.

Myocarditis

Myocarditis, or congestive heart failure, is a condition characterized by symptoms of coronary heart disease (chest pain, shortness of breath, palpitations), elevated cardiac output (indicating heart failure), and electrocardiographic (ECG), cardiac imaging. (heart disease). echocardiogram, cardiac magnetic resonance imaging) and / or cardiac biopsy.

Although rare, myocarditis with COVID-19 is more common in men. Because myocarditis is associated with an increased risk of coronary heart disease, an emergency management system should be developed to care for these individuals. For patients with mild or moderate myocarditis, it is recommended to go to the hospital to be closely monitored for severe symptoms, while testing and treatment are continued. Patients with severe myocarditis should be hospitalized in centers that specialize in the development of coronary heart disease, mechanical blood support and other therapies.

Myocarditis following COVID-19 mRNA vaccine is also rare. As of May 22, 2021, the U.S. Immunization Program has observed a total of 40.6 cases per million after the second batch of vaccines among men aged 12-29 and 2.4 times per million between men aged> 30. The average in females was 4.2 and 1 times per million, respectively. Although most cases of myocarditis following the prevention of COVID-19 mRNA are mild, it should be identified and treated equally with myocarditis after exposure to COVID-19. It is currently accepted that COVID-19 mRNA inhibitors are highly effective, and the risk-benefit ratio is very good in all population groups evaluated so far.

Dogon COVID

The complications that follow SARS-CoV-2 (PASC) infection, commonly known as long-term COVID, are a condition that is reported by about 10-30% of infected people. It is defined by a group of newcomers, relapses or health problems that people experience four weeks or more after exposure to COVID-19. While people with this condition may experience a wide range of symptoms, tachycardia, motor impairment, chest pain and shortness of breath represent some of the symptoms that attract attention to. cardiovascular system.

The writing committee recommended two guidelines to better understand the potential side effects for those with symptoms of heart disease:

  • PASC-CVD, or PASC-Heart Disease, refers to a large group of coronary heart disease conditions (including myocarditis) that appear at least four weeks after exposure to COVID-19.
  • PASC-CVS, or PASC-Cardiovascular Disease, involves a range of symptoms of cardiovascular disease without accurate evidence of coronary heart disease by following standard testing.

In general, patients with long-term COVID and symptoms of coronary heart disease should be tested laboratory tests, ECG, echocardiogram, ambulatory rhythm monitoring and / or additional lung testing depending on the clinical presentation. It is recommended to consult a cardiologist for the results of abnormal test results, with further evaluation depending on the underlying clinical condition (e.g., myocarditis).

Because of the many factors that can cause PASC-CVS, assessment and management may be the best cause of the high incidence of coronary heart disease. For those with tachycardia and exercise intolerance, increased sleep and / or decreased exercise can lead to a reduction in heart disease along with continued heart disease and symptoms.

Nicole Bhave, MD, co-president of the group, said: “There are ‘low’ symptoms for long-term residents of COVID. Fatigue and reduced physical activity lead to reduced function and stability, which in turn leads to serious illness. and reduce quality of life, ”said Nicole Bhave, MD, co-president of the organization. professional decision-making process. “The review committee recommended further cardiovascular assessments to determine whether additional specialized care and medical treatment were needed for these patients.”

For PASC-CVS patients with tachycardia and motor impairment, upright exercise (walking or running) should be replaced with strenuous or partial exercise (driving, swimming or cycling) to avoid fatigue severe. Exercise intensity and duration should be lower at first, with a gradual increase during long-term exercise. Exercise can be resumed as the individual’s symptoms improve. Additional interventions (salt and water intake, sleep apnea, supportive socks) and medications (beta-blockers) should be considered regularly.

Back to the game

Observations of heart failure among some hospitalized patients with COVID-19, combined with uncertainty about the incidence of post-traumatic stress disorder mild illness, has caused early fears about the safety of competitive games for athletes recovering from COVID-19 infection. Subsequent data from major registries showed a decrease in clinical myocarditis in general, without increasing the incidence of coronary heart disease. In this regard, the updated guide is provided with a practical, evidence-based guide to guide the recovery of sports and intensive exercise training.

For athletes recovering from COVID-19 with progressive cardiopulmonary diseasechest pain, shortness of breath, heart rate, lightheadedness) or those who need hospitalization with increased suspicion of cardiac arrest, further evaluation with ECG test, cardiac trop and echocardiogram — should be performed . For those with abnormal test results, further evaluation should be considered with a magnetic resonance imaging (MRI) scan. People diagnosed with clinical myocarditis should stop exercising for three to six months.

Cardiac testing is not recommended for asymptomatic people after exposure to COVID-19. Individuals should abstain from training for three days to ensure that symptoms do not develop. For those with low or moderate symptoms of heart disease (fever, fatigue, muscle aches), training may continue after the onset of symptoms. For those with chronic heart disease (uku three months) with no signs of coronary heart disease, it is recommended to exercise slowly without the need for a heart test.

In light of the low incidence of myocarditis observed in professional athletes with COVID-19, the authors noted that these recommendations may be applied more cautiously in high school athletes (age ≥14) with older adults. recreational exercise. Further studies are needed, however, to better understand how long heart disease persists after exposure to COVID-19 and the role of exercise in long-term COVID.


MRI sheds light on coronary heart disease associated with COVID prevention


Learn more:
Ty J. Gluckman et al, 2022 ACC Expert Consensus Pathway on COVID-19 Cardiovascular Sequelae in Adults: Myocarditis and Other Myocardial Injuries, After Death of SARS-CoV-2, and Back Play: Report by the American College of Cardiology and the Board of Trustees, Journal of the American Academy of Cardiology (2022). DOI: 10.1016 / j.jacc.2022.02.003

hint: A new guide for physicians on the effects of COVID-19 cardiovascular disease (2022, March 16) Retrieved 16 March 2022 from https://medicalxpress.com/news/2022-03-expert-clinical-guidance-issued -cardiovascular.html

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