Via Research Recognition Day Program VCOM-Carolinas 2025

Clinical Educational Research

The Negative Effects of Long COVID-19 on Cardiovascular Health and Implications for the Presurgical Examination https://doi.org/10.1515/jom-2024-0109

Hannah L. Stimart, OMS-IV 1 , Brittany Hipkins, MD 2 1. Edward Via College of Osteopathic Medicine, Spartanburg, SC 2. Blue Ridge Health, Sylva, NC

Introduction

Results

Discussion

The coronavirus disease 2019 (COVID-19) pandemic, first identified in December 2019, has been shown to be a complex inflammatory disease with potential for multisystemic injury. In recent years, there has been increasing evidence of long-term complications following recovery from acute COVID-19 infection, thus introducing the term “long COVID”. Though a universal definition for long COVID has yet to be established, it is important to recognize that long COVID can impact multiple organ systems, including the cardiovascular (CV) system, unfavorably. Adverse sequelae may range from chest pain and arrhythmias to heart failure, myocardial infarction, or sudden cardiac death. For any post-acute COVID-19 patient requiring a surgical procedure, the potential for cardiac injury secondary to long COVID-19 must be considered. Thus, the research question prompting this study is: “How does long COVID -19 impact the presurgical cardiac examination of an adult scheduled to undergo a noncardiac procedure?”. Peer-reviewed and journal-published articles were selected based on established inclusion and exclusion criteria. A total of 6,675 studies were retrieved from PubMed and Google Scholar to address the posed scientific question. Following screening, 60 studies were included in final consideration. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) structure was implemented for study selection. Methods

It is evident that long COVID-19 can negatively impact the cardiovascular system and present in many different forms. There are currently no standardized recommendations to dictate an approach to presurgical cardiac examination in the context of long COVID-19. The following are a few of the recommendations we put forward for consideration: - Low threshold to assess long COVID patients for CV morbidity - Early cardiologist involvement in the setting of persistent CV symptoms and/or abnormal cardiac test results - Baseline EKG and assessment of orthostatic BP, HR for those experiencing cardiac symptoms The decision regarding if/when to proceed with surgery should weigh the increased risk of perioperative hazards with the potential threat of delaying the procedure. Conclusions Acute COVID-19 infection is proposed to be a significant driver for the development of cardiovascular disease in many different forms. - Long COVID-19 does not discriminate which patients it affects by means of acute-phase disease severity or existing comorbidities - Long COVID-19 may affect multiple multiple organ systems, including the cardiovascular system - Those patients who develop long COVID-19 are at higher risk of developing long-term cardiac complications than those who do not - These cardiac complications may impact presurgical cardiac fitness

Selected articles were analyzed for the mention of symptomatology pertaining to the following categories: (1) chest pain, (2) arrhythmias, (3) blood pressure changes, (4) myocarditis/pericarditis, (5) heart failure, (6) cardiomyopathy, (7) orthostatic intolerance, and (8) thromboembolic events. The prevalence of symptoms mentioned in the studies is represented in Figure 2 , which demonstrates the number of times that the specific symptom was encountered across the assessed articles.

Figure 2. The prevalence of symptoms mentioned in the reviewed literature

The percentage of the total number of symptoms mentioned for which each of these categories account is portrayed in Figure 3 .

Future Aims

- Continued studies to elucidate the pathophysiology of long COVID-19 - Long-term surveillance of COVID-19 survivors in order to characterize the permanence (or lack thereof) of long-lasting deleterious effects - Surgical outcomes in those with history of COVID-19 infection during a particular timeframe in contrast to those who have not has an infection documented in the same period

References

- For full list of references, please see https://doi.org/10.1515/jom-2024-0109

Acknowledgements - None; No IRB approval indicated; No outside grants or funding

Figure 1. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow chart .

Figure 3. Cardiovascular manifestations of long COVID-19

2025 Research Recognition Day

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