In many places worldwide, the worst part of the pandemic is still to come. Meanwhile, in other areas, the number of cases is rising again. In this context, the long-term effects of COVID-19 are starting to show.
Many believe this is not a current issue, but it will definitely be a problem in the future.
It is paramount to detect cardiovascular morbidities and complications in order to mitigate active infections. These include myocarditis, infarction, stroke, venous thromboembolism and multisystem inflammatory syndrome in children.
There is little information about what happens after the acute phase; however, recent publications have begun to shed some light on its impact.
The work done by Dr. Puntmann et al. showed that 78% of adult patients who recovered from COVID-19 presented some type of myocardial involvement. Said involvement was, in most cases, an inflammation diagnosed by magnetic resonance imaging and positive ultra-sensitive troponin. The results derived from magnetic resonance imaging differ from those from autopsies. In the latter, the evidence of myocarditis from COVID-19 is up to 10x lower than in magnetic resonance imaging.
This difference between imaging and anatomical pathology may possibly be caused by overinterpretation of the former, which could be mimicking inflammation. Physiological and technical variables might play a role.
Other coronaviruses, such as SARS and MERS, caused myocarditis in extremely rare cases. Unless this new coronavirus SARS-CoV-2 is functionally different from its predecessors, we should not expect long-term cardiac inflammation.
This pandemic proven the importance of anatomical pathology studies. Quality autopsies made it possible to calibrate clinical, radiological, and laboratory findings during the course of the infection.
These autopsies mostly showed that the large number of pathological findings in the cardiovascular system were secondary to inflammation and not directly caused by the virus.
Lastly, the public health risk caused by COVID-19 should be balanced with other more individual aspects of health, such as physical, mental, and emotional wellbeing.
Referencia: Joseph J. Maleszewski et al. Circulation. 2020 Sep 24. Online before print. DOI: 10.1161/CIRCULATIONAHA.120.051362.
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