ACC Offers Guidance on Cardiovascular Sequelae of COVID-19
Guidelines address myocarditis and other types of myocardial involvement, postacute sequelae of SARS-CoV-2, and return to exercise
FRIDAY, March 18, 2022 (HealthDay News) -- In a 2022 Expert Consensus Decision Pathway issued by the American College of Cardiology and published online March 16 in the Journal of the American College of Cardiology, guidance is provided for the evaluation and management of adults exhibiting cardiovascular sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Ty J. Gluckman, M.D., from the Providence Heart Institute in Portland, Oregon, and colleagues developed a document to address commonly asked questions relating to care of adults with cardiac symptoms after SARS-CoV-2 infection. The guidance addressed myocarditis and other types of myocardial involvement, approaches to dealing with postacute sequelae of SARS-CoV-2 infection (PASC), and return to exercise.
The authors note that in the case of increased suspicion for cardiac involvement in COVID-19, initial testing should include an electrocardiogram (ECG), cardiac troponin (cTn) measurement, and echocardiogram. Those with increasing cTn and/or ECG or echocardiographic abnormalities concerning for myocarditis should undergo cardiology consultation. Patients with definite myocarditis that is mild or moderate in severity are recommended to be hospitalized, ideally at an advanced heart failure center. Myocarditis is rare following COVID-19 mRNA vaccination, with the highest rates seen in young men (aged 12 to 17 years) after the second dose. PASC -- a constellation of new, returning, or persistent health problems experienced four or more weeks after acute SARS-CoV-2 infection -- can include known cardiovascular conditions or a range of cardiovascular symptoms without objective evidence of cardiovascular disease. Cardiology consultation is recommended if patients have abnormal cardiac test results, known cardiovascular disease with evidence of worsening, documented cardiac complications during acute illness, and/or persistent unexplained cardiopulmonary symptoms. Detailed recommendations are provided on return to exercise and play for individuals and athletes following SARS-CoV-2 infection.
"Given that it reflects the current state of knowledge through early 2022, it is anticipated that recommendations will change over time as our understanding evolves," the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.