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Ask the Doc: Post-COVID Syndrome

Ask the Doc: Post-COVID Syndrome

Dr. Victoria Shin, FACC, and Chair Division of Cardiology, and family medicine Dr. Panteha Rezaeian, FASPC, both with Torrance Memorial Physician Network, answer questions related to post-COVID-19 syndrome.

What is post-COVID syndrome?

Dr. Victoria Shin: Many people who survive COVID infection recover without residual sequelae. But some people, even those who had mild versions of the disease, continue to experience symptoms after their initial recovery. These people sometimes describe themselves as "long haulers" and the condition has been called post-COVID-syndrome or "long COVID-19."

Dr. Panteha Rezaeian: The COVID-19 virus is similar to other viruses such as SARS and MERS and leaves some infected individuals with long term chronic and debilitating symptoms. It is important to note those who suffer from Post- COVID Syndrome do not have the active virus and are not contagious. Their symptoms are due to the response of the body to the virus. Scientists are trying to discover the possible mechanism/s of this response, which include:

  • Excess inflammation
  • Blood clots
  • Blood vessel damage
  • Dysautonomia (dysregulation of the autonomic nervous system which is responsible for involuntary functions, like blood pressure, heart rate, breathing, and digestion).

What are some of the symptoms of post-COVID-19?

Dr. Victoria Shin: The most common signs and symptoms that linger over time include:

  • Fatigue
  • Shortness of breath
  • Cough
  • Joint pain
  • Chest pain
  • Brain Fog
  • Headache
  • Intermittent fever

Dr. Panteha Rezaeian: More severe or life-threatening long-term consequences are less common and can include:

  • Cardiovascular: heart attack, stroke, heart muscle inflammation, heart failure
  • Neurological: Memory and concentration problems, disturbance of smell and taste sensation, sleep problem
  • Respiratory: Lung function abnormalities
  • Renal: acute kidney injury or kidney failure
  • Integumentary system: rash, hair loss
  • Psychiatric: Mood changes such as anxiety or depression

What are some residual heart symptoms?

Dr. Victoria Shin: A decrease in exercise capacity is the most common, though it is sometimes hard to tease out whether it is due to the lungs or the heart as they work in conjunction. Patients also often complain of palpitations -- their hearts racing for no reason. Occasionally they have chest pain at rest or with activity.

A growing number of studies suggest many COVID-19 survivors experience some type of heart damage, even if they didn't have underlying heart disease and weren't sick enough to be hospitalized. This latest twist has us worried about a potential increase in heart failure down the road.

Myocarditis, an inflammation of the heart muscle, could lead to an increase in heart failure during the initial infection -- a dire consequence, as often these patients do very poorly. Or even patients who were not that sick may have sub-clinical myocarditis which may lead to heart failure down the road.

Nearly one-fourth of those hospitalized with COVID-19 have been diagnosed with cardiovascular complications, which have been shown to contribute to roughly 40% of all COVID-19-related deaths.

Two recent studies suggest heart damage among those infected may be more widespread. In JAMA Cardiology, an analysis of autopsies done on 39 COVID-19 patients identified infections in the hearts of patients who had not been diagnosed with cardiovascular issues while they were ill.

Another JAMA Cardiology study used cardiac MRIs on 100 people who had recovered from COVID-19 within the past two to three months. Researchers found abnormalities in the hearts of 78% recovered patients and "ongoing myocardial inflammation" in 60%. Most patients in the study had not required hospitalization.

Things that are unclear:

1) who is more at risk for developing cardiac complications post-COVID

2) whether screenings to detect cardiovascular damage should become a routine part of follow-up care for COVID-19 patients

What are some ways to cope with these symptoms?

Dr. Panteha Rezaeian: The most effective way to prevent Post-COVID Syndrome is to take necessary precautions in order to prevent COVID-19 infection. COVID-19 survivors who experience long-term symptoms should seek medical attention and further evaluation from their doctor. As we evolve our knowledge about the different aspects of PCS and how to treat it, experts strongly recommend improving lifestyle intervention such as breathing-work technique, adequate sleep, enough rest and avoiding physical or emotional stress.

Some studies indicate that healthy breathing – breathing through the nose with fewer but deeper breaths per minute- will activate a chain of events through the autonomic nervous system (parasympathetic) resulting in lowers stress and anxiety, better sleep, and positive effects on other symptoms.

Improving sleep by getting longer, higher-quality sleep time is another way to cope with PCS. A significant part of physical and mental recovery happens during sleep. Previous studies show sleep deprivation negatively affects body recovery for various health conditions, even after getting a flu vaccine. It is important for COVID-19 infected individuals to take plenty of time to recover before returning to regular activities. Recovery is slow and gradual and requires significant patience.

How do you encourage your patients to be safe during the pandemic?

Dr. Victoria Shin: From the beginning, I have strongly recommended masking, social distancing, avoid gatherings. And now that we are fortunate enough to have the vaccine, I highly recommend everyone get it when their turn comes. The vaccination effort is crucial in order to reduce the spread before the virus further mutates into more virulent variants. It is trying to outsmart us every day and it's a race against time.

Dr. Panteha Rezaeian: As previously mentioned, the best way to treat PCS is to do one’s best to prevent initial infection from the virus. I cannot emphasize enough to take all the recommended and necessary precautions, including wearing a mask , washing hands and social distancing to prevent infection.

Dr. Victoria Shin, , FACC, and Chair Division of Cardiology, and family medicine Dr. Panteha Rezaeian, FASPC, both with Torrance Memorial Physician Network, answer questions related to post-COVID-19 syndrome.