The new COVID Recovery Heart Clinic features a multidisciplinary team of physicians, nurses, imaging experts, and physical therapists.
This month, the Cedars-Sinai health system in Los Angeles opened a dedicated clinic to assess and manage COVID-19 patients who are experiencing persistent cardiac symptoms after recovering from acute illness.
One of the more mysterious characteristics of COVID-19 is a select group of patients who are "long haulers" experiencing symptoms for weeks or months after recovering from the acute phase of the illness. Long haulers have a range of symptoms, including cough, shortness of breath, constitutional symptoms such as numbness and tingling, cardiac issues, hair loss, and deconditioning.
At Cedars-Sinai and across the country, it became clear in the early days of the pandemic that COVID-19 can have profound effects on the cardiovascular system, Siddharth Singh, MD, a staff cardiologist and assistant professor at the Smidt Heart Institute and director of the new COVID Recovery Heart Clinic, recently told HealthLeaders.
"Some of us among the cardiology faculty were closely involved in the care of the first patients in the ICU and medical floors. We got to experience first-hand some of the effects on the heart in COVID-19 patients," he said.
After the spring coronavirus surge, it became clear that COVID-19 long haulers were experiencing persistent cardiac symptoms, Singh said. "As time went along, we started getting calls from physician friends and patients who had recovered from COVID-19 but were having persistent symptoms. In the past couple of months, we started talking amongst ourselves as a group, and we came up with this idea to start a dedicated clinic for COVID-19 patients who had recovered but were actively experiencing cardiac symptoms."
How the COVID Recovery Heart Clinic works
The new clinic features a multidisciplinary team of physicians, nurses, and physical therapists, Singh said. "The COVID Recovery Heart Clinic at Cedars-Sinai is part of a wider institutional mission to better characterize multi-organ involvement in COVID-19 patients. On the cardiology side, we have a team of general cardiologists, imaging experts, and heart failure specialists."
Treatment of patients at the new clinic starts with a thorough history and physical examination, he said. "We check blood work to see whether patients have any signs of ongoing heart damage. We get electrocardiograms and echocardiograms, which is ultrasound of the heart to check the pumping function of the heart and to see whether we can identify any subtle signs that would suggest some decline in heart function."
In patients who have clinical features that would suggest arrhythmias, the clinic conducts ambulatory heart rhythm monitoring to make sure patients are not experiencing heart rhythm issues, Singh said.
Advanced imaging is conducted on some patients, he said. "Based on blood work, when we suspect ongoing heart involvement, we are performing state-of-the-art imaging with cardiac MRI to investigate whether there is any swelling or inflammation in the heart muscle."
Athletic patients receive a unique course of care, Singh said. "In selected cases where patients want to go back to rigorous athletics, we advise patients against vigorous exercise for two or three months after their recovery from COVID-19. Once they have recovered, we will perform exercise testing to ensure that they can go back to rigorous exercise safely."
Cardiovascular conditions common in COVID-19 patients
Coronavirus patients can experience a range of cardiovascular conditions, Singh said.
- Myocardial injury
- Myocarditis, which is inflammation of the heart muscle
- Abnormal clotting linked to inflammation of the lining of blood vessels
- Septic cardiomyopathy or stress cardiomyopathy, which are forms of reversible heart failure that are seen in critically ill patients with or without COVID-19
- Low blood pressure or elevated heart rate linked to cytokine storm
- Heart attacks
- The right ventricle of the heart tends to become weaker or fail in patients who have severe pneumonia from COVID-19
- Arrhythmias can affect anywhere from 30% to 50% of severely ill COVID-19 patients
COVID-19 patients recovering from the illness should be on guard for several cardiac-related symptoms, Singh said. "Symptoms that patients should be on the lookout for are persistent chest pain with exertion or without exertion, shortness of breath especially with exertion, palpitations, swelling in the legs, feeling faint or dizzy, passing out spells, and feeling very fatigued with physical activity."
Christopher Cheney is the CMO editor at HealthLeaders.
KEY TAKEAWAYS
Coronavirus "long haulers" experience persistent symptoms for weeks or months after the acute phase of the illness.
Long haulers can have a range of cardiac symptoms, including shortness of breath, palpitations, swelling in the legs, feeling faint or dizzy, and passing out spells.
At the new Cedars-Sinai clinic, evaluation of long haulers with cardiac symptoms includes blood work, electrocardiograms, echocardiograms, and cardiac MRI.