How to diagnose and treat long COVID cardiac symptoms

It is not difficult to diagnose cardiac symptoms of long COVID, although access to imaging would help inform differential diagnosis, according to a physician who is leading a study into long COVID symptoms. Treat patients based on the symptoms present, said Dr. Thao Huynh, epidemiologist and cardiologist at the McGill University Health Centre (MUHC) and lead investigator in the IMPACT QUEBEC COVID-19 Long Haul Study, which is examining 200 patients with long COVID symptoms, focusing on cardiac issues. “Often it is quite easy to make this diagnosis." The most common symptoms reported by long COVID patients are shortness of breath, chest pain and heart palpitations, Dr. Huynh said. The palpitations may be present with or without chest pains, and are often orthostatic. Patients with long COVID can have their heart rate soar from 70 beats per minute to 140 beats per minute when they stand up, she said. “It is actually quite easy to recognize with the change in position,” she said. Patients may also have orthostatic hypotension. Dr. Huynh advised measuring blood pressure after 10 minutes of standing, which she's found is more accurate in these patients than after five minutes. Patients who experience orthostatic dizziness without tachycardia or hypotension can be monitored with 24-hour blood pressure and heart rate monitoring. Read: Long COVID symptom profile may differ depending on variant of infection Dr. Huynh advises patients with orthostatic hypotension to drink plenty of fluids, increase salt uptake, wear waist-high compression stockings, keep their heads elevated by 10-to-15 cm while sleeping. If the chest pain increases with respiration or cough and the patient has a negative d-dimer, this can be treated as pericarditis, she said. The Canadian Cardiovascular Society published guidance about diagnosing and treating cardiac long COVID symptoms in March 2021. The guidance suggest that a cardiologist should be consulted when patients who were diagnosed with COVID-19 more than a month ago present with the following symptoms: persistent or unexplained chest pain (more likely to have a cardiac etiology when other cardiac risk factors are present), shortness of breath (more likely to have a cardiac etiology if elevated BNP, left ventricular dysfunction or evidence of pulmonary edema are present), frequent palpitations (more likely to have a cardiac etiology when syncope or arrhythmia are present), postural light headedness (more likely to have a cardiac etiology when orthostatic hypotension is documented) The Canadian Cardiovascular Society also provides a list of investigations to determine the underlying cause of cardiac long COVID-19 symptoms. Treatment should be based on established guidelines for the symptoms present. Read: Post-Acute COVID-19 Syndrome Cardiac symptoms are often reported alongside other more general long COVID symptoms, such as fatigue and cognitive symptoms such as brain fog. Dr. Huynh said that the patients she is seeing were often healthy before contracting COVID-19, but now struggle with exhaustion and emotional stress. Most of the patients she sees were infected in the first wave and have been sick for two years. “We have seen 200 patients and the majority of them feel that they cannot go back to work,” she said. “I think it is important that family physicians recognize these symptoms, and treat the patient with respect and empathy,” Dr. Huynh said. “They are not lazy people. They are far from that. They want to go back to work, but they just can’t. It’s exhausting for them.” Read: Montreal study shows effectiveness of fluvoxamine against COVID-19

How to diagnose and treat long COVID cardiac symptoms

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