Myocardial injury in COVID-19 and cardiac arrhythmias in acute and long-term periods

Epidemiologic data indicate that up to 30% of individuals surviving the acute phase of COVID-19 experience persistent cardiovascular symptoms, including dyspnea, chest pain and discomfort, palpitations, exercise intolerance, pathological fatigue, and sleep disturbances. Numerous investigations worldwide have shown that patients, regardless of age, race, sex, or cardiovascular risk factors, remain at increased risk for cardiovascular complications after recovery from COVID-19, including new-onset or progressive inflammatory heart diseases, heart failure, myocardial infarction, ischemic heart disease, cardiomyopathy, thromboembolism, cardiac arrhythmias, and ischemic stroke. SARS-CoV-2 not only induces direct cardiomyocyte injury or damages other cardiovascular system cells but also causes systemic inflammation and coagulopathy, which may exacerbate comorbid cardiovascular diseases. Functional and instrumental diagnostic methods have revealed various forms of subclinical and clinical cardiac injury in most patients with post-COVID syndrome, regardless of the severity of the acute COVID-19 phase or coexisting conditions. The high prevalence of post-COVID cardiovascular syndrome underscores the need for a comprehensive, multidisciplinary approach to diagnosis, treatment, and rehabilitation. Authors of published investigations, meta-analyses, and systematic reviews consistently emphasize the importance of monitoring cardiovascular status for at least one year after recovery from infection. This review article highlights the need to investigate the pathophysiology of post-COVID cardiovascular syndrome to identify potential therapeutic targets and develop targeted treatment strategies.