Medical Technology

COVID-19 Post-Acute syndrome Can masquerade as a New CV Diagnosis

This is a brief summary of an unpublished research study by the authors of Yale School of Medicine on MedRxiv, which is provided to you by Medscape. The study has not yet been peer-reviewed. includes the full report of this study.

The most important takeaways

  • In this cohort of 126 patients who were referred to an cardiology clinic for the post-acute effects of SARS-CoV-2 infection (PASC) which is also referred to as COVID long, the examination resulted in a cardiovascular disease (CVD) diagnosis in 23%.

  • The remaining patients (77 percent) had symptoms that are related to exercise intolerancefor example, fatigue, dyspnea on exertion, tachycardia and chest pain, which the researchers termed “cardiovascular PASC syndrome.” Three of these patients had postural orthostatic tachycardia syndrome.

Why it is it important?

  • There is not much literature on the cardiovascular manifestations of COVID.

  • This study identifies a need for multidisciplinary teams as well as accelerated research to better phenotype and treat this heterogeneous patient population.

Study Design

  • The study was conducted on the electronic records of consecutive patients with COVID that was long-lasting, and who were directed to a cardiology center between September 2021 between September 2021 and May 2020.

  • The patient’s examinations included baseline vital signs including cardiopulmonary physical examination ECG as well as echocardiogram, laboratory studies as well as the active stand test (in patients with orthostatic intolerance), and other tests guided by clinical judgment to identify cardiovascular disease.

Key Results

  • The 126 patients had a median age of 44 years (range 19-74 years) 91% of them were younger than 65 and 66% of them were female.

  • Most patients had had mild (37%) or moderate (41%) acute COVID-19; less had had severe (11 percent) or critical (9 percent) acute COVID 24% of patients were admitted to hospital.

  • On average, they appeared at the CV clinic 5.1 months after receiving a COVID diagnosis.

  • Most patients reported dyspnea (52%; “almost always exertional”) or chest pressure or pain (48 percent) 44% reported experiencing palpitations (44 percent).

  • Other symptoms that are common include brain fog (17%), headache (11 percent) and lightheadedness (10 10%).

  • The CVD diagnoses in 23% of patients included nonischemic cardiomyopathy (4.8%) new Ischemia (3.2 percent), new atrial fibrillation (2.4%)) coronary vasospasm (1.6 percent), and new supraventricular Tachycardia (1.6%). Myocardial involvement as assessed by cardiac MRI was seen in 15 percent.

  • The severity of acute COVID-19 was lower. was a significant predictor for cardiovascular PASC syndrome.


  • These patients were seen in a single cardiology practice with a significant number of patients with long COVID, so the findings may not be generalizable.

  • The researchers cut down on the number of diagnostic tests as their experience increased. However, all patients had an extensive cardiovascular physical exam, ECG, and echocardiogram.

  • Based on cardiac MRI It isn’t clear if myocardial involvement could be clinically relevant.

  • While new diagnostic algorithms for the diagnosis are still being developed it is possible to identify PASC cardiovascular syndrome by making better diagnoses.


  • Senior study author Erica S. Spatz, MD, MHS, Yale School of Medicine, New Haven, Connecticut, is coprincipal investigator on the Centers for Disease Control and Prevention-funded study, Innovative Support for Patients with SARS-COV2 Infections (COVID-19) Registry (INSPIRE); and receives funding from the US Food and Drug Administration as part of the Yale University-Mayo Clinic Center for Excellence in Research, Science and Innovation (CERSI) as well as the National Institute on Minority Health and Health Disparities, and the National Institute of Biomedical Imaging and Bioengineering.

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