scholarly journals Exercise Training and Cardiac Rehabilitation in COVID-19 Patients with Cardiovascular Complications: State of Art

Life ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 259
Author(s):  
Mariaconsiglia Calabrese ◽  
Marina Garofano ◽  
Roberta Palumbo ◽  
Paola Di Pietro ◽  
Carmine Izzo ◽  
...  
Keyword(s):  
Exercise Training ◽  
Cardiac Rehabilitation ◽  
Cardiovascular System ◽  
Patient Monitoring ◽  
Scientific Evidence ◽  
Cardiovascular Complications ◽  
Angiotensin Converting Enzyme 2 ◽  
Coronary Syndrome ◽  
Cardiovascular Damage ◽  
Include Heart Failure

Recent scientific literature has investigated the cardiovascular implications of COVID-19. The mechanisms of cardiovascular damage seem to involve the protein angiotensin-converting enzyme 2 (ACE2), to which severe acute respiratory syndrome (SARS) coronavirus-2 (CoV-2) binds to penetrate cells and other mechanisms, most of which are still under study. Cardiovascular sequelae of COVID-19 include heart failure, cardiomyopathy, acute coronary syndrome, arrhythmias, and venous thromboembolism. This article aims to collect scientific evidence by exploiting PubMed, Scopus, and Pedro databases to highlight the cardiovascular complications of COVID-19 and to define the physiotherapy treatment recommended for these patients. Exercise training (ET), an important part of cardiac rehabilitation, is a powerful tool in physiotherapy, capable of inducing significant changes in the cardiovascular system and functional in the recovery of endothelial dysfunction and for the containment of thromboembolic complications. In conclusion, due to the wide variety of possible exercise programs that can be obtained by combining intensity, duration, and speed in various ways, and by adjusting the program based on continuous patient monitoring, exercise training is well suited to the treatment of post-COVID patients with an impaired cardiovascular system of various degrees.

scholarly journals Cardiovascular system and coronavirus disease-2019 (COVID-19): mutual injuries and unexpected outcomes

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Eman Sobh ◽  
Muhammad Saad Reihan ◽  
Tamer M. S. Hifnawy ◽  
Khloud Gamal Abdelsalam ◽  
Sohaila Sabry Awad ◽  
...  
Keyword(s):  
Cardiovascular System ◽  
Poor Prognosis ◽  
Clinical Decision ◽  
Cardiovascular Complications ◽  
Main Body ◽  
Negative Consequences ◽  
Coronary Syndrome ◽  
System A ◽  
High Index Of Suspicion ◽  
Unexpected Outcomes

Abstract Background Cardiovascular system involvement in coronavirus disease-2019 (COVID-19) has gained great interest in the scientific community. Main body Several studies reported increased morbidity and mortality among COVID-19 patients who had comorbidities, especially cardiovascular diseases like hypertension and acute coronary syndrome (ACS). COVID-19 may be associated with cardiovascular complications as arrhythmia, myocarditis, and thromboembolic events. We aimed to illustrate the interactions of COVID-19 disease and the cardiovascular system and the consequences on clinical decision as well as public health. Conclusions COVID-19 has negative consequences on the cardiovascular system. A high index of suspicion should be present to avoid poor prognosis of those presenting with unusual presentation.

scholarly journals Do Patients Maintain Proper Long-Term Cardiopulmonary Fitness Levels After Cardiac Rehabilitation? A Retrospective Study Using Medical Records

2021 ◽  
Vol 45 (2) ◽  
pp. 150-159
Author(s):  
Chul Kim ◽  
Hee Eun Choi ◽  
Jin Hyuk Jang ◽  
Jun Hyeong Song ◽  
Byung-Ok Kim
Keyword(s):  
Retrospective Study ◽  
Exercise Training ◽  
Cardiac Rehabilitation ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Hospital Setting ◽  
Aerobic Exercise Training ◽  
Cardiopulmonary Fitness ◽  
Coronary Syndrome

Objective To examine whether patients who participated in a cardiac rehabilitation (CR) program after hospitalization for acute coronary syndrome maintained cardiorespiratory fitness (CRF) in the community.Methods We conducted a retrospective study including 78 patients who underwent percutaneous coronary intervention or coronary artery bypass graft surgery at our hospital’s cardiovascular center and participated in a CR program and a 5-year follow-up evaluation. Patients were divided into a center-based CR (CBCR) group, participating in an electrocardiography-monitored exercise training in a hospital setting, and a home-based CR (HBCR) group, receiving aerobic exercise training and performed self-exercise at home.Results No significant differences were found between groups (p>0.05), except the proportion of non-smokers (CBCR 59.5% vs. HBCR 31.7%; p=0.01). In both groups, the maximal oxygen consumption (VO<sub>2max</sub>) increased significantly during the first 12 weeks of follow-up and remained at a steady state for the first year, but it decreased after the 1-year follow-up. Particularly, VO<sub>2max</sub> at 5 years decreased below the baseline value in the HBCR group. In the low CRF group, the CRF level significantly improved at 12 weeks, peaked at 1 year, and was still significantly different from the baseline value after 5 years. The high CRF group did not show any significant increase over time relative to the baseline value, but most patients in the high CRF group maintained relatively appropriate CRF levels after 5 years.Conclusion Continuous support should be provided to patients to maintain optimal CRF levels after completing a CR program.

scholarly journals Cardiovascular Health and Risk Management in Cancer Survivors

2020 ◽  
Vol 18 (7.5) ◽  
pp. 1004-1006
Author(s):  
Javid J. Moslehi
Keyword(s):  
Cardiovascular Disease ◽  
Cancer Survivors ◽  
Cardiovascular System ◽  
Cardiovascular Health ◽  
Checkpoint Inhibitors ◽  
Angiogenesis Inhibitors ◽  
Cardiovascular Complications ◽  
Cancer Treatments ◽  
Cardiovascular Damage ◽  
Similar Risk

Cardio-oncology is a growing field, due to several factors. These include the recognition that similar risk factors predispose people to both cardiovascular disease and cancer. In addition, certain cancers affect the heart, and cancer treatments can have short-term and long-lasting deleterious effects on the cardiovascular system. More than 40 years ago, it became evident that anthracyclines and radiation cause heart damage, and since then the list of cancer treatments that can harm the cardiovascular system has grown to include more modern treatments, such as anti-HER2 agents and angiogenesis inhibitors. Most recently, immune checkpoint inhibitors (ICIs) have been added to the list of cancer treatments that cause cardiovascular damage. ICI-associated myocarditis is a relatively rare but fatal complication that develops rapidly after initiating immunotherapy. Oncologists should be aware of the potential cardiovascular complications of cancer treatments, and should assess the cardiovascular health of all patients about to undergo therapy. Cancer survivors should be assessed and advised about prevention and treatment that may be needed to address cardiovascular disease.

Abstract 3543: Long-Term Benefits of Cardiac Rehabilitation in Patients With Incomplete Revascularization: 5-Year Follow-up.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Romualdo Belardinelli ◽  
Francesca Lacalaprice ◽  
GianPiero Piccoli ◽  
Gianfranco Iacobone ◽  
Roberto Piva
Keyword(s):  
Coronary Artery ◽  
Exercise Training ◽  
Cardiac Rehabilitation ◽  
Artery Bypass ◽  
Intervention Group ◽  
Exercise Stress ◽  
Control Group ◽  
Coronary Syndrome ◽  
Peak Vo2 ◽  
Incomplete Revascularization

There is evidence that cardiac rehabilitation (CR) determines important benefits in patients with coronary artery disease(CAD). However, it is unclear whether CR may improve the outcome of pts with incomplete revascularization (IR) after PTCA/stenting and/or coronary artery bypass surgery (CABG). From 1/1/2002 to 30/11/2004, we prospectively studied 259 patients with CAD who underwent PTCA after a SCA or CABG in 1(10/7%, respectively), 2(20/19%) and 3 major coronary arteries (70/74%). Patients were randomized into 2 homogeneous groups on the basis of the results of cardiopulmonary exercise stress testing(CPET) performed twice one week apart: a group with a positive CPET for inducible ischemia (P, n=129), and a group with a negative CPET (N, n=130). Patients were further randomized into 2 groups. The intervention group(Group CR) received CR combining exercise training (60%peak VO2, 3 times a week for 8 weeks)+ nutrition counseling+ standard medications (65P+65N, 25% women, mean age 56±8 years), while the control group (Group C) had no CR (65P+64N, 25% women, mean age 58±8 years). On entry and at 8 weeks all patients underwent CPET, brachial artery flow-mediated dilation (BA-FMD) and blood chemistry. Group CR-N had more marked improvements in peak VO2 and FMD than CR-P (P<0.001 for both). However, CPET became negative in 22% post PTCA CR-P patients and 28% post CABG CR-P (P<0.001 vs initial). After 8 weeks, group CR was recommended to continue a home program of exercise training with periodic supervision at the hospital’s gym, while group C was not. At 5 years, both peak VO2 and FMD were significantly higher in CR (P<0.01 vs C) with no differences between CR-P and CR-N. Cardiovascular risk profile (CVRP) was significantly improved in CR (P<0.01 vs C). Cardiac events were significantly lower in CR than C : new acute coronary syndrome (P<0.001); new PCI (P<0.0001); new CABG(P<0.001); hospital readmission: (P<0.0001); cardiac death (P<0.05). Multivariate analysis demonstrated that the lower rate of events in CR was not collinear with changes in CVRP. In conclusion, IHD patients with IR take advantage from CR and maintain a higher functional capacity and a better control of CVRP at 5 years. These benefits were associated with a better outcome.

scholarly journals Human Stem Cell Models of SARS-CoV-2 Infection in the Cardiovascular System

2021 ◽  
Author(s):  
Kyle Ernzen ◽  
Aaron J. Trask ◽  
Mark E. Peeples ◽  
Vidu Garg ◽  
Ming-Tao Zhao
Keyword(s):  
Cardiovascular System ◽  
Myocardial Injury ◽  
Clinical Manifestations ◽  
Angiotensin Converting Enzyme 2 ◽  
Coronary Syndrome ◽  
Differentiated Cells ◽  
Global Pandemic ◽  
Bidirectional Relationship ◽  
Stem Cell Models ◽  
Pro Inflammatory Cytokines

AbstractThe virus responsible for coronavirus disease 2019 (COVID-19), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has infected over 190 million people to date, causing a global pandemic. SARS-CoV-2 relies on binding of its spike glycoprotein to angiotensin-converting enzyme 2 (ACE2) for infection. In addition to fever, cough, and shortness of breath, severe cases of SARS-CoV-2 infection may result in the rapid overproduction of pro-inflammatory cytokines. This overactive immune response is known as a cytokine storm, which leads to several serious clinical manifestations such as acute respiratory distress syndrome and myocardial injury. Cardiovascular disorders such as acute coronary syndrome (ACS) and heart failure not only enhance disease progression at the onset of infection, but also arise in hospitalized patients with COVID-19. Tissue-specific differentiated cells and organoids derived from human pluripotent stem cells (hPSCs) serve as an excellent model to address how SARS-CoV-2 damages the lungs and the heart. In this review, we summarize the molecular basis of SARS-CoV-2 infection and the current clinical perspectives of the bidirectional relationship between the cardiovascular system and viral progression. Furthermore, we also address the utility of hPSCs as a dynamic model for SARS-CoV-2 research and clinical translation. Graphical abstract

scholarly journals Mechanisms of Damage to the Cardiovascular System in COVID-19

2021 ◽  
Vol 76 (3) ◽  
pp. 287-297
Author(s):  
Alexandr Y. Fisun ◽  
Yuriy V. Lobzin ◽  
Dmitry V. Cherkashin ◽  
Vadim V. Tyrenko ◽  
Konstantin N. Tkachenko ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiovascular System ◽  
Heart Muscle ◽  
Cardiac Death ◽  
Myocardial Damage ◽  
Angiotensin Converting Enzyme 2 ◽  
Coronary Syndrome ◽  
Life Threatening ◽  
Potential Benefits ◽  
Myocardial Involvement

The review article is devoted to the analysis of the literature on the various mechanisms of damage to the cardiovascular system in COVID-19. The article briefly outlines the epidemiology and urgency of the COVID-19 problem, describes the features of the clinical picture of heart muscle damage in COVID-19. The pathophysiology, morphology and pathogenetic mechanisms of myocardial involvement in cases of SARS-CoV-2 lesion are considered in detail. The authors present a diagram of various mechanisms of myocardial damage in COVID-19, which includes mediated damage to the heart muscle through angiotensin-converting enzyme 2, myocardial damage caused by hypoxemia, microvascular heart damage, and systemic inflammatory response syndrome. A detailed scheme of cardiomyocyte infection with the involvement of cytokines, which ultimately leads to myocardial remodeling and dilated cardiomyopathy, is presented. The pathophysiological foundations of the development of sudden cardiac death in COVID-19, which include the mechanisms of life-threatening arrhythmias, acute coronary syndrome, and heart failure, are considered. The authors analyzed scientific studies of the toxic effects of COVID-19 drug treatment on the heart muscle, in particular, antiviral, antibacterial, antimalarial agents. Their potential benefits and harms, as well as the likelihood of developing cardiovascular events, in particular sudden cardiac death, were assessed.

scholarly journals COVID-19 and the Cardiovascular System: How the First PostModern Pandemic ‘Weakened’ our Hearts

2020 ◽  
Vol 3 ◽  
pp. e15
Author(s):  
Syeda Tasneem Towhid ◽  
◽  
Nadira Naznin Rakhi ◽  
ASM Shamsul Arefin ◽  
Otun Saha ◽  
...  
Keyword(s):  
Cardiovascular System ◽  
Cardiac Injury ◽  
Age Groups ◽  
Signs And Symptoms ◽  
Holistic Approach ◽  
Cardiovascular Complications ◽  
Cardiac Complications ◽  
Cardiovascular Damage ◽  
Preventative Measures ◽  
Life Threatening

The global spread of SARS-CoV-2 with its diverse signs and symptoms manifested in COVID-19 patients across different age groups and geographic locations perplexed the clinicians and public health experts. Emerging variants of SARS-CoV-2 through continuous mutation with a limited arsenal of treatment made the study of viral pathogenesis and factors associated with disease outcomes in a holistic approach inevitable, among which pre-existing cardiovascular complications were found to be significantly associated with adverse outcome of COVID-19. In addition, COVID-19 has already been reported to cause cardiac injury and different cardiovascular complications in patients irrespective of preexisting cardiovascular complications, which highlights the importance of recognizing the complications at the onset, although these arising complications might be an indirect effect of SARS-CoV-2 induced cytokine storm or hypoxia rather the virus itself. Also, the drugs used for the clinical management of the patients may have an impact on the induced cardiac complications. Thus, the effect of SARS-CoV-2 on the cardiovascular system needs to be investigated in order to predict the clinical outcome and to devise a proper treatment strategy. Besides, the interaction of vaccines or therapeutics to be approved with the cardiovascular system needs to be evaluated to avoid confounding effects leading to cardiovascular complications followed by post-approval retraction. However, potential biomarkers (eg. troponin, D-dimers, fibrin) associated with cardiac injury may be potentially useful in predicting life-threatening conditions early enough to save lives. In conclusion, this review summarizes the molecular pathogenesis of cardiovascular damage caused by SARS-CoV-2 in COVID-19 patients, as well as prescribed treatment and preventative measures.

scholarly journals Impact of and Reasons for Not Performing Exercise Training After an Acute Coronary Syndrome in the Setting of an Interdisciplinary Cardiac Rehabilitation Program: Results From a Risk-Op- Acute Coronary Syndrome Ambispective Registry

2021 ◽  
Vol 12 ◽  
Author(s):  
Ignacio Cabrera-Aguilera ◽  
Consolació Ivern ◽  
Neus Badosa ◽  
Ester Marco ◽  
Luís Salas-Medina ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Exercise Training ◽  
Cardiac Rehabilitation ◽  
Primary Endpoint ◽  
Multivariable Analysis ◽  
Rehabilitation Program ◽  
Work Schedule ◽  
Structural Barriers ◽  
Coronary Syndrome

Background and Aims: Exercise training (ET) is a critical component of cardiac rehabilitation (CR), but it remains underused. The aim of this study was to compare clinical outcomes between patients who completed ET (A-T), those who accepted ET but did not complete it (A-NT), and those who did not accept to undergo it (R-NT), and to analyze reasons for rejecting or not completing ET.Methods and Results: A unicenter ambispective observational registry study of 497 patients with acute coronary syndrome (ACS) was carried out in Barcelona, Spain, from 2016 to 2019. The primary endpoint was a composite of all-cause mortality, hospitalization for ACS, or need for revascularization during follow-up. Multivariable analysis was carried out to identify variables independently associated with the primary outcome. Initially, 70% of patients accepted participating in the ET, but only 50.5% completed it. The A-T group were younger and had fewer comorbidities. Baseline characteristics in A-NT and R-NT groups were very similar. The main reason for not undergoing or completing ET was rejection (reason unknown) or work/schedule incompatibility. The median follow-up period was 31 months. Both the composite primary endpoint and mortality were significantly lower in the A-T group compared to the A-NT and R-NT (primary endpoint: 3.6% vs. 23.2% vs. 20.4%, p &lt; 0.001, respectively; mortality: 0.8% vs. 9.1% vs. 8.2%, p &lt; 0.001; respectively). During multivariable analysis, the only variables that remained statistically significant with the composite endpoint were ET completion, previous ACS, and anemia.Conclusion: Completion of ET after ACS was associated with improved prognosis. Only half of the patients completed the ET program, with the leading reasons for not completing it being refusal (reason unknown) and work/schedule incompatibility. These results highlight the need to focus on the needs of patients in order to guarantee that structural barriers to ET no longer exist.

scholarly journals Post COVID-19 Conditions and the Cardiovascular System

2021 ◽  
Author(s):  
Iana Simova ◽  
Denislava Hristova ◽  
Hristina Tzanovska ◽  
Denis Nikolov ◽  
Diliana Iakova ◽  
...  
Keyword(s):  
Cardiovascular System ◽  
Personal Experience ◽  
Signs And Symptoms ◽  
Limb Ischemia ◽  
Cardiovascular Complications ◽  
Medical Attention ◽  
Acute Limb Ischemia ◽  
Coronary Syndrome ◽  
Campaign Life ◽  
Rhythm Disorder

One out of four patients affected by COVID-19 will experience persistent (>3-4 weeks) signs and symptoms (Post COVID-19 conditions or Post-Acute Sequelae of SARS-CoV-2 – PASC) and this fact will have a major significance for the healthcare and economic systems in the upcoming years. The cardiovascular system is one of the key targets for the Post COVID-19 syndrome, given the pathogenesis of the virus and prevalence of ACE-2 receptors. According to our initial personal experience via the campaign “Life after COVID” of the Bulgarian Cardiac Institute, a substantial proportion of patients having suffered from COVID-19 develop long-term cardiovascular consequences. They could range from rhythm disorder and blood pressure variation, through impairment of myocardial mechanics and heart failure, and to acute vascular manifestations of Post COVID-19 conditions, such as acute coronary syndrome, acute pulmonary embolism, and acute limb ischemia. These cardiovascular complications require special and dedicated medical attention, and we could share our personal experience on the matter.

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