Victoria SergeevaSaratov State Medical University named after V.I. Razumovsky, Russian Federation
Title: Cardiovascular manifestations of COVID-19 and post-COVID-19 syndrome: cause for concern
In Russia, more than 13 million people have been infected with COVID-19. Cardiovascular symptoms, both in the acute period of a new coronavirus infection and in the post-COVID-19 period, are among the most common and cause great concern regarding the further prognosis for patients. Some survivors of COVID-19 reported different form of cardiovascular disease prior to infection, but a significant number have experienced these symptoms for the first time. Many pathogenesis aspects of the new coronavirus infection directly affect the development and progression of cardiovascular diseases in recovered patients. Fatigue (asthenia), sleep disturbances (SD) and cognitive dysfunction (CD) are also among the most common clinical manifestations in post-COVID-19 syndrome (PCS). The variety of symptoms in PCS, reducing working capacity and, in general, the quality of life of a significant number of people, including young people, dictates the need for further study of the problem in order to develop possible rehabilitation approaches and restore their health as soon as possible.
The aim of the study was to research and compare the most common clinical manifestations of the acute period of COVID-19 and PCS among women of different age groups.
Methods: 253 women of different age groups who had COVID-19 were examined at the outpatient stage using a voluntary anonymous questionnaire regarding the presence of clinical manifestations of the acute period of COVID-19 and PCS. The Modified Medical Research Council scale was used to assess the severity of dyspnea, McNair and Kahn Scale to assess CD, the FSS (Fatigue Severity Scale) for fatigue accessing, SD were assessed by clinical interview. In each group, there was approximately the same distribution of study participants according to the severity of COVID-19. The exclusion criteria were decompensated chronic diseases, oncological pathology, pronounced disorders of intellectual and memory functions. Statistical processing was carried out using StatPlus 2009 Professional software.
Results: Among young women (18-44 years old) (n=135), mean age 36(28; 41) years old, at baseline, 24.44% had risen blood pressure (BP), including 9.63% had diagnosed with arterial hypertension (AH), 2.22% of IHD. As symptoms of COVID-19 among young women, 34.81% noted palpitations, 14.81% high blood pressure, 9.63% various pains in the heart. Shortness of breath, which in the context of COVID-19 can be associated with both hypoxemia due to lung tissue damage and myocardial damage, was observed in 27.41% of young women in the acute phase of the disease, and according to our data, was not always directly related to the volume of lung injury. Among middle-aged women (n=85), mean age 50 (48; 54.75) years, AH was initially present in 40%, 2.35% had chronic forms of coronary artery disease. Among the cardiovascular symptoms of the acute phase of COVID-19, palpitations and increased blood pressure each accounted for 34.12%, cardiac pain - 10.59% of cases; shortness of breath was detected in 44.71% of women in this group. Among elderly women (n=33), mean aged 63 (61; 66.75) years, initially 48.48% had AH, 12.12% had various forms of coronary artery disease. Palpitations in the acute period of COVID-19 were observed in 27.27% of elderly women, cardiac pain in 18.18%, increased BP - in 36.36%. Shortness of breath was present in 30.30% of older women. In PCS in young women, palpitations were noted in 33.33% of cases, cardialgia in 11.85%, rises in BP in 14.81%, 8.89% of women noted a decrease in blood pressure. For the first time in PCS, edema of the lower extremities was noted in 26.67% of young women. In middle-aged women in PCS, palpitations are observed in 30.59% of cases, cardialgia - in 11.76%, increased BP - in 25.88%, swelling of the lower extremities - in 28.24% of cases. Among elderly women, 36.36% in PCS had palpitations, 15.15% had cardialgia, 45.45% had raised BP, and 33.33% noted the appearance of edema of the lower extremities. There was a statistical pattern in the increase in the prevalence of AH in the PCS among women of the middle age group compared with young women (?2=16.441, p<0.001) and older women compared with young women (?2=15.094, p<0.001). Shortness of breath in the PCS was noted in 24.44% of young, 21.18% of middle and 27.27% of elderly women. In each age group, about a third of women had CV events for the first time after experiencing COVID-19.
Fatigue was the leading syndrome both in the acute period of COVID-19 (it was observed in 86.67% of young women, 67.06% of middle-aged women and 78.79% of elderly women) and in PCS in women of all age groups (in 61.48% young women, 61.18% of middle-aged women and 57.58% of older women (p>0.05)). Statistically significant differences in the frequency of registration of fatigue were obtained by comparing the group of young and middle-aged women in the acute period of infection (p<0.05), and among young women, fatigue was recorded with statistical significance more often. In groups of young and middle-aged women, fatigue tended to be more pronounced with an increase in the severity of the course of COVID-19. We can also see an increase in the number of respondents with fatigue as the severity of COVID-19 increases. Attention is drawn to the strong statistical dependence of CD and its severity on the severity of the course of COVID-19 in the group of young women. In the subgroups of mild and moderate course of COVID-19, a correlation of fatigue and CD was also obtained, which opens up new prospects for the study and drug treatment of these disorders. Among elderly women, there were no statistically significant differences in the manifestation of fatigue and CD depending on the severity of the COVID-19 infection. Of course, with age, the number of comorbid conditions increases and the influence of external factors that can affect these indicators increases. CD was observed in about a third of older women, regardless of the severity of COVID-19.
Fatigue, as one of the dominant clinical manifestations of PCS, was analyzed in women of different age groups depending on the severity of dyspnea. A statistical relationship was obtained between the severity of dyspnea and the level of fatigue in young women (?2=3.934, p=0.048) and elderly women (?2=4.342, p=0.038), in the group of elderly women, an average positive correlation was also found between the severity of dyspnea and the level of fatigue (r=0.558, p=0.0007).
SD was noted by 69.96% of the study participants. Statistical significance of a higher frequency of detection of SD among older women than among young women was established (?2=4.491; p=0.035). Also, older women were more likely than young women to have nocturnal awakenings and lack of sleep (?2=5.498; p=0.020). SD in women was directly related to anxiety and depression. Among women reporting SD, 45.45% noted anxiety, among women without SD, anxiety was detected in 20.78% (?2=13.851; p<0.001; average relationship K=0.234). Depressive mood was found in 57.39% of women with SD and in 22.08% of women without SD (?2=26.833; p<0.001; mean relationship, K=0.326). The relationship between SD and fatigue as the leading clinical manifestations of PCS was studied. Among women with SD, 67.05% had an FSS score of 36 or more, i.e. noted pronounced fatigue, weakness. Among women without SD, 48.05% of respondents had such results. In the group of women without SD, the average score on this questionnaire was 35 (18.25; 50.5), in the group of women with SD 45 (27; 55). A statistically significant difference was obtained in the severity of fatigue on the FSS scale between the groups (Kolmogorov-Smirnov test p=0.0191; Mann-Whitney test p=0.0136). A statistical relationship between SD and the presence of fatigue was also obtained (?2=8.143; p=0.005).
Conclusion. The new coronavirus infection, in addition to the main symptoms of an infectious disease, is accompanied by a manifestation of a large number of cardiovascular symptoms, which may also persist in the post-COVID-19 period. These manifestations among women of various age groups should considered as the alarming sign of development of many cardiovascular diseases and requires a complete examination of the cardiovascular system of such patients. Fatigue, cognitive dysfunction, and sleep disturbances are the most common post-COVID syndromes and are often overlooked when interviewed by general practitioners. The relationship of various clinical manifestations should be taken into account when assessing rehabilitation measures in the management of patients with post-COVID-19 syndrome.
Victoria A. Sergeeva - Candidate of Medical Sciences, assistant professor of the department of Therapy with Courses of Cardiology, Functional Diagnostics and Geriatrics, Saratov State Medical University n.a. V.I. Razumovsky