Unraveling the Cardiovascular Legacy of COVID-19: Implications for Modern Cardiac Care

As the global healthcare system grapples with the ramifications of the COVID-19 pandemic, the persistent cardiovascular implications are emerging as a critical focus for ongoing cardiac care. The sweeping influence of long COVID on cardiovascular health necessitates urgent and evolving management strategies to combat these pervasive effects, a priority underscored by major cardiology society statements and consensus pathways.

The cardiovascular impact of COVID-19 is multifaceted, prompting calls for structured, risk-stratified follow-up. Reports describe post-acute concerns including myocardial injury and thromboembolic events, though estimates vary by age, vaccination status, and severity of the acute illness. This heterogeneity supports a tailored approach to monitoring and evaluation.

Among post-COVID cardiac concerns, myocarditis and cardiomyopathy have been reported in observational cohorts at low absolute frequency. Evaluation is generally symptom-driven, beginning with clinical assessment, ECG, and troponin, with echocardiography and cardiac MRI considered when indicated; individual case reports illustrate potential severity. Absolute risks vary across populations and by illness severity, and diagnostic ascertainment differs among studies.

Current care pathways continue to evolve, emphasizing careful history and physical examination, ECG and troponin when indicated, and judicious use of imaging. Biomarkers such as natriuretic peptides (e.g., NT-proBNP) can support evaluation of suspected heart failure in post-COVID patients, but they are adjuncts rather than standalone diagnostics.

Taken together, these threads point to a pragmatic, patient-centered approach: target testing to symptoms and risk, focus on functional recovery, and revisit plans as evidence matures. Health systems can support this work by embedding standardized symptom checklists, creating referral pathways to cardiology and rehabilitation services, and ensuring equitable access to follow-up.

Key Takeaways:

• Cardiovascular effects after COVID-19 are heterogeneous; most risks are low at the individual level but warrant attention in symptomatic or high-risk groups.
• Evaluation should be risk-stratified and symptom-driven, using history/exam with ECG and troponin as indicated, and selective imaging when warranted, consistent with major society guidance.
• Management emphasizes rehabilitation, comorbidity optimization, and targeted testing or therapies when clinically indicated, reflecting an evidence-informed, patient-centered approach.