Click Here to Download this Blog Post –  Long COVID Syndrome and the Cardiovascular System: A Review of Neuroradiologic Effects on Multiple Systems

Nicholas L. DePace · Joe Colombo

© The Author(s), under exclusive license to Springer Science+Business Media, LLC, part of Springer Nature 2022 

Abstract 

Purpose of Review Long-COVID syndrome is a multi-organ disorder that persists beyond 12 weeks post-acute SARS-CoV-2  infection (COVID-19). Here, we provide a definition for this syndrome and discuss neuro-cardiology involvement due to the  effects of angiotensin-converting enzyme 2 receptors (the entry points for the virus), inflammation, and (3) oxidative  stress (the resultant effects of the virus). 

Recent Findings These effects may produce a spectrum of cardio-neuro effects (e.g., myocardial injury, primary arrhythmia,  and cardiac symptoms due to autonomic dysfunction) which may affect all systems of the body. We discuss the symptoms  and suggest therapies that target the underlying autonomic dysfunction to relieve the symptoms rather than merely treating  symptoms. In addition to treating the autonomic dysfunction, the therapy also treats chronic inflammation and oxidative stress.  Together with a full noninvasive cardiac workup, a full assessment of the autonomic nervous system, specifying parasympathetic and sympathetic (P&S) activity, both at rest and in response to challenges, is recommended. Cardiac symptoms must be  treated directly. Cardiac treatment is often facilitated by treating the P&S dysfunction. Cardiac symptoms of dyspnea, chest  pain, and palpitations, for example, need to be assessed objectively to differentiate cardiac from neural (autonomic) etiology.

Summary Long-term myocardial injury commonly involves P&S dysfunction. P&S assessment usually connects symptoms  of Long-COVID to the documented autonomic dysfunction(s).

Click Here to Download this Blog Post – History of Long COVID

COVID-19 was reported in Wuhan, China in December 2019. It is caused by a small novel coronavirus. The acute phase of COVID-19 infected patients has been well described and may a have varying number of symptoms and intensity. The majority of patients have fever, sore throat, cough, shortness of breath, and chest pain. Although, multiorgan involvement may become extensive. COVID symptoms may be identified in six clusters [1]. These include: 1. Flu-like with no fever, which consist of headache, loss of smell or taste, cough, muscle pains, sore throat, chest pains. 2. Flu-like with fever, which consists of headache, loss of smell or taste, cough, sore throat, hoarseness, fever, loss of appetite. 3. Gastrointestinal, which consists of headache, loss of smell or taste, loss of appetite, diarrhea, sore throat, chest pain, but no cough. 4. Severe level one, fatigue with headache, loss of smell or taste, cough, fever, hoarseness, chest pain. 5. Severe level two, which consists of confusion with head ache, loss of smell, loss of appetite, cough and fever, hoarse ness, sore throat, chest pain, fatigue, and muscle pain. 6. Severe level three, which is abdominal and respiratory dysfunction with headache, loss of smell or taste, loss of appetite, cough, fever, hoarseness, chest pain, fatigue, sore throat, confusion, muscle pain, diarrhea, shortness of breath and abdominal pain. The recovery from COVID-19 usually occurs at seven to ten days after the onset of symptoms in mild disease but could take up to six weeks in severe or critical illness. It is for this reason that mild cases are usually quarantined for between 7-10 days, and severe illnesses are for a more extended period of time. However, it is believed that even when one is ill for 3-6 weeks, they are probably not actively contagious. Some studies have shown that active coughing is indicative of continuing contagiousness. This has not been clarified. Studies have shown that household cases support the highest incidences of contagious ness and that rational for masks appears to be most beneficial with close contacts for prevention. The most common feature of acute illness is interstitial pneumonia, which may in some cases be complicated by the serious acute respiratory distress syndrome where individuals require high doses of oxygen. This has a high mortality particularly in elderly people who have comorbidities. The cough is usually dry. Laboratory abnormalities may be present and include low lymphocyte counts, elevated inflammatory markers, such as Sed Rate, C-reactive protein, Ferritin, Interleukin 1 and 6, and Tu mor Necrosis Factor abnormalities, and others, which will be discussed later. Coagulation system abnormalities may occur (to be discussed later). Clots may form in the acute phase as well as in the subacute phase, especially if there is a history of clots.

Long-Covid Syndrome: A Multi-Organ Disorder Research Article 1 Franklin Cardiovascular Assoc., PA and Autonomic Dysfunction and POTS Center, Sicklerville, NJ, USA 2 Pennsylvania Hospital of the University of Pennsylvania Health System, Philadelphia, PA, USA 3 Neuro-Cardiology Research Corporation, LLC, Wilmington, DE, USA 4 CTO and Sr. Medical Director, Physio PS, Inc., Atlanta, GA, USA Nicholas L DePace1,2,3, Joe Colombo1,3,4* * Corresponding author Joe Colombo, Franklin Cardiovascular Assoc., PA and Autonomic Dysfunction and POTS Center, Sicklerville, NJ and Neuro-Cardiology Research Corporation, LLC, Wilmington, DE, CTO and Sr. Medical Director, Physio PS, Inc., Atlanta, GA, USA. Submitted: 04 Mar 2022; Accepted: 14 Mar 2022; Published: 23 Mar 2022

Copyright: ©2022 Joe Colombo. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Click Here to Download this Blog Post – Long-Covid Syndrome: A Multi-Organ Disorder Research Article 1

SARS-CoV-2 Infection COVID-19 is a major pandemic that is worldwide and causing significant mortality and morbidity. About 80% have mild to moderate disease. However, among the 20% with severe disease, 5% develop a critical illness. There is a subset of patients, however, who will have lingering, persistent or prolonged symptoms for weeks or month afterwards, which we termed “Post-Acute Sequelae of SARS-CoV-2 infection” syndrome or simply the “Post-Acute COVID-19 Syndrome” or “Long COVID-19” or just “Long COVID” or “Long Haulers COVID-19” or simply “Long Haulers” or “Post-Covid Syn drome.”

This has extended the significant worldwide morbidity from this pandemic. It is estimated that about 10% of patients who tested positive for SARS-COVID-19 will remain ill beyond three weeks and a smaller proportion for months. This is a sub set that constitutes the Long-COVID syndrome. Globally, there are estimated over 200 million confirmed cases of COVID-19. Although the majority of infected individuals recover, we still do not know the exact percentage that will continue to experience symptoms or complications after the acute phase of the illness is over.

This prolonged phase with morbidity and ongoing symptoms creates significant burden to the patient and burden to the health care system and is not completely understood. To complicate matters, not only do the long-term effects of those infected by the virus remain largely unknown, but there are also reports highlighting that sustained transmission and emergent variants continue to cause challenges to healthcare providers throughout the world, and therefore we do not know when the pandemic will cease. While it is estimated that 10% will develop a chronic syndrome, or symptoms that are persistent, this statistic may actually increase. Since this is a new illness, we do not know the cause or characteristics of the long-term sequelae of someone who has recovered from acute COVID, not just the quality of life, including mental health, but the employment and productivity issues become paramount when the acute phase of COVID, the subacute, and the chronic phases occur. In our experience, approximately 20% of people will exhibit symptoms for more than five weeks and 10% will have symptoms for more than 12 weeks.

Franklin Cardiovascular Assoc., PA and Autonomic Dysfunction and POTS Center, Sicklerville, NJ, USA 2 Pennsylvania Hospital of the University of Pennsylvania Health System, Philadelphia, PA, USA 3 Neuro-Cardiology Research Corporation, LLC, Wilmington, DE, USA 4 CTO and Sr. Medical Director, Physio PS, Inc., Atlanta, GA