New information regarding COVID-19 continues to emerge daily. This content was based on the sources available at the time of writing.
As evidence of COVID-19's involvement in cardiac complications continues to emerge, the literature has introduced the need for ongoing surveillance among patients who have recovered from known and suspected infections — even when those infections were mild and occurred months ago.
One study in JAMA Cardiology, for example, found that 78% of a 100-patient cohort experienced abnormalities in cardiac MRI, with the most common being myocardial inflammation at 60%. Detectable troponin was found in 71% of patients, which is more than twice the rate estimated in a white paper from the Journal of the American Heart Association that capped at 27.8%. The median time between COVID-19 diagnosis and MRI was 71 days, and most patients recovered at home instead of the hospital.
The JAMA Cardiology paper in particular has stirred concern among both patients and providers, making headlines worldwide and inspiring new dialogue around the long-term consequences of a virus initially thought to be isolated to the respiratory system.
Unlike previous research in the Heart Rhythm Journal, which affirmed COVID-19's risk of acute ischemic damage in hospitalized patients, the JAMA Cardiology paper added new worries to the conversation by discussing potential long-term effects among otherwise healthy people who have experienced a mild form of COVID-19.
A New Wave of Cardiac Patients
These new insights suggest that a wave of heart patients may need care post-recovery to account for potential long-term cardiac issues, such as cardiomyopathy and cardiac arrhythmias.
As trends tying COVID-19 to such conditions take shape, they are reinforcing the need for ongoing surveillance in the wake of what the Heart Rhythm Journal researchers now call "post-COVID-19 cardiac syndrome." Exactly what that surveillance would and should look like is still under investigation, but one thing is clear: diagnostic tools such as ECG offer a fast and convenient bedside testing option for patients of all risk levels.
Using ECG to Identify COVID-19's Cardiac Complications
While hospitalized COVID-19 patients may have the benefit of lab testing, echocardiography and advanced imaging at the point of care, patients who have recovered from a mild infection may not have baseline cardiac metrics for reference. Still, knowing a patient's history of suspected or confirmed COVID-19 infection can help inform diagnostic planning well beyond recovery of the acute illness.
If medical history and physical exam warrant an ECG, clinicians will want to familiarize themselves with abnormalities that may indicate lasting complications from a COVID-19 infection, particularly arrhythmias (Afib specifically) and sinus tachycardia and conduction defects due to myocarditis. This article contains ECG indicators for each category of complications.
To learn more about the power of the ECG in today's clinical landscape, browse our Diagnostic ECG Clinical Insights Center.
Other Ways the Pandemic Has Affected Cardiac Care
Additionally, the impact of elective surgery deferment and postponement of necessary cardiac care in the acute setting may have long-term consequences. Not only have guidelines-based interventions been paused in various locales, but patients themselves are more reluctant to visit the emergency department as well. Beth Israel's Cardiac Critical Care Unit, for example, experienced heart attack declines in its ED of 33%, as the Harvard Gazette reports.
These trends paint a troubling picture of patients who may experience acute injury that advances into lasting damage. While more investigation is needed, the growing evidence of long-term cardiovascular consequences tied to COVID-19 underscores the need for more diligence in diagnostic decision-making.
Indeed, the ramifications of post-COVID-19 cardiac syndrome may persist for some time. Fortunately, ECG will always be there to help identify abnormalities that may come with this new wave of cardiac patients.