European Heart Journal:

Management of cardiometabolic risk factors should become a priority for physicians. The long-term impact of COVID-19 on cardiovascular (CV) health and mortality is also emerging as a major global concern.

Non-pharmacological supportive approaches:

The management of long COVID tends to be largely supportive. Given the strong association between obesity and long COVID, measures to reduce weight through caloric restriction, diet, tailored graded exercise, stress reduction, and good sleep hygiene could be beneficial in the long run, with growing evidence indicating its favorable effects on systemic inflammation, vascular dysfunction, and metabolic syndrome.

Non-pharmacological approaches including pulmonary rehabilitation, breathing exercise, and alternative therapies (e.g. singing therapy, acupuncture, body rotation, and stretching) have also been suggested to help breathlessness symptoms. Those returning to work may benefit from phased return, allowing individuals with incomplete mental and physical recovery to gradually resume employment.

Given that psychosocial factors are a major determinant of incomplete recovery, early referral for mental health assessment/cognitive behavioural therapy may benefit some patients.

Pharmacological management:

In individuals with complicated (non-COVID) myocarditis the The European Society of Cardiology (ESC) and The American Heart Association (AHA) recommend Endomyocardial Biopsy (EMB) to guide specific treatment options (e.g. immunomodulatory therapy vs. antivirals). Currently, there is no COVID-19 specific guidance on this, though several studies are underway to evaluate the most effective management strategy.

The efficacy of oral non-steroidal anti-inflammatory drugs and/or colchicine is also being evaluated for COVID-19-associated pericarditis.

For the management of post-COVID-19 acute coronary syndromes, heart failure patients are typically treated in accordance with the ESC and AHA guidelines.

There are currently no published trials on the efficacy of prolonged thromboprophylaxis post-acute COVID-19

Postural orthostatic tachycardia syndrome and symptoms of dysautonomia can be debilitating for patients.

In some patients with ongoing palpitations, beta-blockers can be helpful in treating symptoms. Graded exercise programmes encouraging patients to adopt an upright posture may attenuate postural symptoms after prolonged bed rest. Compression panty-hose style stockings with 30–40 mmHg counter pressure may help symptoms of orthostatic hypotension through reduced peripheral venous pooling.

In the event that symptoms persist despite compliance with the aforementioned approaches, pharmacological therapies (e.g. ivabradine, fludrocortisone, midodrine, clonidine, and methyldopa) may be considered.

CT computed tomography; ECG electrocardiography; POTS Postural Orthostatic Tachycardia Syndrome; SPECT Single Photon Emission Computed Tomography; CCTA coronary computed tomography angiography; CMR cardiac magnetic resonance; ESC The European Society of Cardiology; AHA The American Heart Association; EMB Endomyocardial Biopsy