COVID-19 Post-Acute Syndrome Can Masquerade as New CV Diagnosis

Marlene Busko

December 13, 2021

This is a summary of a preprint research study written by authors from Yale School of Medicine on MedRxiv provided to you by Medscape. This study has not yet been peer-reviewed. The full text of the study can be found on

Key Takeaways

  • In this cohort of 126 patients referred to a cardiology clinic for post-acute effects of SARS-CoV-2 infection (PASC), also known as long COVID, assessment led to a cardiovascular disease (CVD) diagnosis in 23%.

  • The remaining patients (77%) had symptoms that are associated with exercise intolerance — including fatigue, dyspnea on exertion, tachycardia, and chest pain — which the researchers termed "cardiovascular PASC syndrome." Three of these patients had postural orthostatic tachycardia syndrome.

Why This Matters

  • There has been limited literature about cardiovascular manifestations of long COVID.

  • This study identifies a need for multidisciplinary teams and accelerated research to better phenotype and treat this heterogeneous patient group.

Study Design

  • This was an observational study based on electronic health records of consecutive patients with long COVID who were referred to a cardiovascular clinic between May 2020 and September 2021.

  • The patient evaluations included baseline vital signs, cardiopulmonary physical examination, ECG, laboratory studies, echocardiogram, active stand test (in patients with orthostatic intolerance), and other tests guided by clinical judgment to identify cardiovascular disease.

Key Results

  • The 126 patients had a mean age of 44 years (range, 19 - 74 years); 91% were younger than 65 and 66% were female.

  • Most patients had had mild (37%) or moderate (41%) acute COVID-19; fewer had had severe (11%) or critical (9%) acute COVID; 24% had been hospitalized.

  • On average, they presented at the CV clinic 5.1 months after a COVID diagnosis.

  • Most presented with dyspnea (52%, "almost always exertional"), chest pain or pressure (48%), or palpitations (44%); 84% of patients had at least one of these symptoms.

  • Other common symptoms were brain fog (17%), headache (11%), and lightheadedness (10%).

  • The CVD diagnoses in 23% of the patients included nonischemic cardiomyopathy (4.8%), new ischemia (3.2%), new atrial fibrillation (2.4%), coronary vasospasm (1.6%), and new supraventricular tachycardia (1.6%). Myocardial involvement by cardiac MRI was observed in 15%.

  • Lower severity of acute COVID-19 was a significant predictor of cardiovascular PASC syndrome.  


  • These patients were seen in a single cardiology practice with a high volume of patients with long COVID, so the results may not be generalizable.

  • The researchers reduced the number of diagnostic tests as their experience increased; however, all patients had a thorough cardiovascular physical exam, ECG, and echocardiogram. 

  • The clinical relevance of myocardial involvement based on cardiac MRI is unclear.

  • New diagnoses that better define PASC cardiovascular syndrome may emerge, although diagnostic algorithms remain to be developed.   


  • Senior study author Erica S. Spatz, MD, MHS, Yale School of Medicine, New Haven, Connecticut, is coprincipal investigator on the Centers for Disease Control and Prevention–funded study, Innovative Support for Patients With SARS-COV2 Infections (COVID-19) Registry (INSPIRE); and receives funding from the US Food and Drug Administration as part of the Yale University–Mayo Clinic Center of Excellence in Regulatory Science and Innovation (CERSI), the National Institute on Minority Health and Health Disparities, and the National Institute of Biomedical Imaging and Bioengineering.

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