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Published in: Cardiology and Therapy 3/2023

Open Access 15-07-2023 | SARS-CoV-2 | Case Series

Complications of SARS-CoV-2 Infection During Cardiac Rehabilitation: A Case Series

Authors: Martina Zappa, Paolo Verdecchia, Andrea Andolina, Antonio Spanevello, Fabio Angeli

Published in: Cardiology and Therapy | Issue 3/2023

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Abstract

Introduction

Vaccination strongly reduces the risk of hospitalization and death due to coronavirus disease 2019 (COVID-19). However, the severity of the acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and the degree of protection exerted over time by vaccination remains to be fully elucidated among hospitalized comorbid and vulnerable patients with SARS-CoV-2 infection.

Methods

We report a case series of nine hospitalized vulnerable patients who developed a SARS-CoV-2 infection during a cardiac rehabilitation inpatient program.

Results

Age ranged from 50 to 81 years. All but one patient had received at least three doses of anti-COVID-19 vaccine more than 4 months before the cardiac event. Indications for cardiac rehabilitation included acute coronary syndromes, congestive heart failure, heart valve surgery, and coronary artery bypass graft. After the confirmed diagnosis of SARS-CoV-2 infection, all patients developed symptoms. Eight patients developed at least one SARS-CoV-2-related complication, including a significant increase in high-sensitivity troponin I levels, new-onset hypoxemia, persistent atrial fibrillation, non-sustained ventricular tachycardia and recurrent sinus arrest, pericardial effusion, and a persistent increase in blood pressure.

Conclusion

Almost all patients developed complications which, however, did not evolve towards more severe expressions of the disease. These data suggest that even in this new phase of the pandemic, vaccination may exert a potential role to reduce the risk of progression towards more severe disease of SARS-CoV-2 infection in vulnerable patients with cardiovascular comorbidities.
Literature
2.
3.
go back to reference Zappa M, Verdecchia P, Spanevello A, Angeli F. Structural evolution of severe acute respiratory syndrome coronavirus 2: implications for adhesivity to angiotensin-converting enzyme 2 receptors and vaccines. Eur J Intern Med. 2022;104:33–6.CrossRefPubMedPubMedCentral Zappa M, Verdecchia P, Spanevello A, Angeli F. Structural evolution of severe acute respiratory syndrome coronavirus 2: implications for adhesivity to angiotensin-converting enzyme 2 receptors and vaccines. Eur J Intern Med. 2022;104:33–6.CrossRefPubMedPubMedCentral
4.
go back to reference Zappa M, Verdecchia P, Angeli F. The new phase of pandemic: Are BA.2.75 and BQ.1 competitive variants? An in silico evaluation. Eur J Intern Med. 2023;108:106–7.CrossRefPubMed Zappa M, Verdecchia P, Angeli F. The new phase of pandemic: Are BA.2.75 and BQ.1 competitive variants? An in silico evaluation. Eur J Intern Med. 2023;108:106–7.CrossRefPubMed
7.
go back to reference Stepanova M, Lam B, Younossi E, Felix S, Ziayee M, Price J, Pham H, de Avila L, Terra K, Austin P, Jeffers T, Escheik C, Golabi P, Cable R, Srishord M, Venkatesan C, Henry L, Gerber L, Younossi ZM. The impact of variants and vaccination on the mortality and resource utilization of hospitalized patients with COVID-19. BMC Infect Dis. 2022;22:702.CrossRefPubMedPubMedCentral Stepanova M, Lam B, Younossi E, Felix S, Ziayee M, Price J, Pham H, de Avila L, Terra K, Austin P, Jeffers T, Escheik C, Golabi P, Cable R, Srishord M, Venkatesan C, Henry L, Gerber L, Younossi ZM. The impact of variants and vaccination on the mortality and resource utilization of hospitalized patients with COVID-19. BMC Infect Dis. 2022;22:702.CrossRefPubMedPubMedCentral
8.
go back to reference Angeli F, Bachetti T, Maugeri Study G. Temporal changes in co-morbidities and mortality in patients hospitalized for COVID-19 in Italy. Eur J Intern Med. 2020;82:123–5.CrossRefPubMedPubMedCentral Angeli F, Bachetti T, Maugeri Study G. Temporal changes in co-morbidities and mortality in patients hospitalized for COVID-19 in Italy. Eur J Intern Med. 2020;82:123–5.CrossRefPubMedPubMedCentral
9.
go back to reference Angeli F, Verdecchia P, Balestrino A, Bruschi C, Ceriana P, Chiovato L, Dalla Vecchia LA, Fanfulla F, La Rovere MT, Perego F, Scalvini S, Spanevello A, Traversi E, Visca D, Vitacca M, Bachetti T. Renin angiotensin system blockers and risk of mortality in hypertensive patients hospitalized for COVID-19: an Italian registry. J Cardiovasc Dev Dis. 2022;9:15.PubMedPubMedCentral Angeli F, Verdecchia P, Balestrino A, Bruschi C, Ceriana P, Chiovato L, Dalla Vecchia LA, Fanfulla F, La Rovere MT, Perego F, Scalvini S, Spanevello A, Traversi E, Visca D, Vitacca M, Bachetti T. Renin angiotensin system blockers and risk of mortality in hypertensive patients hospitalized for COVID-19: an Italian registry. J Cardiovasc Dev Dis. 2022;9:15.PubMedPubMedCentral
10.
go back to reference Angeli F, Zappa M, Oliva FM, Spanevello A, Verdecchia P. Blood pressure increase during hospitalization for COVID-19. Eur J Intern Med. 2022;104:110–2.CrossRefPubMedPubMedCentral Angeli F, Zappa M, Oliva FM, Spanevello A, Verdecchia P. Blood pressure increase during hospitalization for COVID-19. Eur J Intern Med. 2022;104:110–2.CrossRefPubMedPubMedCentral
11.
go back to reference Angeli F, Reboldi G, Spanevello A, De Ponti R, Visca D, Marazzato J, Zappa M, Trapasso M, Masnaghetti S, Fabbri LM, Verdecchia P. Electrocardiographic features of patients with COVID-19: one year of unexpected manifestations. Eur J Intern Med. 2022;95:7–12.CrossRefPubMed Angeli F, Reboldi G, Spanevello A, De Ponti R, Visca D, Marazzato J, Zappa M, Trapasso M, Masnaghetti S, Fabbri LM, Verdecchia P. Electrocardiographic features of patients with COVID-19: one year of unexpected manifestations. Eur J Intern Med. 2022;95:7–12.CrossRefPubMed
12.
go back to reference Angeli F, Spanevello A, De Ponti R, Visca D, Marazzato J, Palmiotto G, Feci D, Reboldi G, Fabbri LM, Verdecchia P. Electrocardiographic features of patients with COVID-19 pneumonia. Eur J Intern Med. 2020;78:101–6.CrossRefPubMedPubMedCentral Angeli F, Spanevello A, De Ponti R, Visca D, Marazzato J, Palmiotto G, Feci D, Reboldi G, Fabbri LM, Verdecchia P. Electrocardiographic features of patients with COVID-19 pneumonia. Eur J Intern Med. 2020;78:101–6.CrossRefPubMedPubMedCentral
13.
go back to reference Angeli F, Marazzato J, Verdecchia P, Balestrino A, Bruschi C, Ceriana P, Chiovato L, Dalla Vecchia LA, De Ponti R, Fanfulla F, La Rovere MT, Perego F, Scalvini S, Spanevello A, Traversi E, Visca D, Vitacca M, Bachetti T. Joint effect of heart failure and coronary artery disease on the risk of death during hospitalization for COVID-19. Eur J Intern Med. 2021;89:81–6.CrossRefPubMedPubMedCentral Angeli F, Marazzato J, Verdecchia P, Balestrino A, Bruschi C, Ceriana P, Chiovato L, Dalla Vecchia LA, De Ponti R, Fanfulla F, La Rovere MT, Perego F, Scalvini S, Spanevello A, Traversi E, Visca D, Vitacca M, Bachetti T. Joint effect of heart failure and coronary artery disease on the risk of death during hospitalization for COVID-19. Eur J Intern Med. 2021;89:81–6.CrossRefPubMedPubMedCentral
15.
go back to reference Marazzato J, De Ponti R, Verdecchia P, Masnaghetti S, Visca D, Spanevello A, Trapasso M, Zappa M, Mancinelli A, Angeli F. Combined use of electrocardiography and ultrasound to detect cardiac and pulmonary involvement after recovery from COVID-19 pneumonia: a case series. J Cardiovasc Dev Dis. 2021;8:133.PubMedPubMedCentral Marazzato J, De Ponti R, Verdecchia P, Masnaghetti S, Visca D, Spanevello A, Trapasso M, Zappa M, Mancinelli A, Angeli F. Combined use of electrocardiography and ultrasound to detect cardiac and pulmonary involvement after recovery from COVID-19 pneumonia: a case series. J Cardiovasc Dev Dis. 2021;8:133.PubMedPubMedCentral
16.
go back to reference Angeli F, Zappa M, Reboldi G, Trapasso M, Cavallini C, Spanevello A, Verdecchia P. The pivotal link between ACE2 deficiency and SARS-CoV-2 infection: one year later. Eur J Intern Med. 2021;93:28–34.CrossRefPubMedPubMedCentral Angeli F, Zappa M, Reboldi G, Trapasso M, Cavallini C, Spanevello A, Verdecchia P. The pivotal link between ACE2 deficiency and SARS-CoV-2 infection: one year later. Eur J Intern Med. 2021;93:28–34.CrossRefPubMedPubMedCentral
17.
go back to reference Angeli F, Reboldi G, Trapasso M, Zappa M, Spanevello A, Verdecchia P. COVID-19, vaccines and deficiency of ACE(2) and other angiotensinases. Closing the loop on the “Spike effect.” Eur J Intern Med. 2022;103:23–8.CrossRefPubMedPubMedCentral Angeli F, Reboldi G, Trapasso M, Zappa M, Spanevello A, Verdecchia P. COVID-19, vaccines and deficiency of ACE(2) and other angiotensinases. Closing the loop on the “Spike effect.” Eur J Intern Med. 2022;103:23–8.CrossRefPubMedPubMedCentral
18.
go back to reference Angeli F, Reboldi G, Verdecchia P. SARS-CoV-2 infection and ACE2 inhibition. J Hypertens. 2021;39:1555–8.CrossRefPubMed Angeli F, Reboldi G, Verdecchia P. SARS-CoV-2 infection and ACE2 inhibition. J Hypertens. 2021;39:1555–8.CrossRefPubMed
19.
go back to reference Angeli F, Reboldi G, Verdecchia P. Ageing, ACE2 deficiency and bad outcome in COVID-19. Clin Chem Lab Med. 2021;59:1607–9.CrossRefPubMed Angeli F, Reboldi G, Verdecchia P. Ageing, ACE2 deficiency and bad outcome in COVID-19. Clin Chem Lab Med. 2021;59:1607–9.CrossRefPubMed
20.
go back to reference Angeli F, Verdecchia P, Reboldi G. Pharmacotherapy for hypertensive urgency and emergency in COVID-19 patients. Expert Opin Pharmacother. 2022;23:235–42.CrossRefPubMed Angeli F, Verdecchia P, Reboldi G. Pharmacotherapy for hypertensive urgency and emergency in COVID-19 patients. Expert Opin Pharmacother. 2022;23:235–42.CrossRefPubMed
21.
go back to reference Angeli F, Zappa M, Reboldi G, Gentile G, Trapasso M, Spanevello A, Verdecchia P. The spike effect of acute respiratory syndrome coronavirus 2 and coronavirus disease 2019 vaccines on blood pressure. Eur J Intern Med. 2023;109:12–21.CrossRefPubMed Angeli F, Zappa M, Reboldi G, Gentile G, Trapasso M, Spanevello A, Verdecchia P. The spike effect of acute respiratory syndrome coronavirus 2 and coronavirus disease 2019 vaccines on blood pressure. Eur J Intern Med. 2023;109:12–21.CrossRefPubMed
22.
go back to reference Angeli F, Zappa M, Verdecchia P. Rethinking the role of the renin-angiotensin system in the pandemic era of SARS-CoV-2. J Cardiovasc Dev Dis. 2023;10:14.PubMedPubMedCentral Angeli F, Zappa M, Verdecchia P. Rethinking the role of the renin-angiotensin system in the pandemic era of SARS-CoV-2. J Cardiovasc Dev Dis. 2023;10:14.PubMedPubMedCentral
23.
go back to reference Verdecchia P, Cavallini C, Spanevello A, Angeli F. COVID-19: ACE2centric infective disease? Hypertension. 2020;76:294–9.CrossRefPubMed Verdecchia P, Cavallini C, Spanevello A, Angeli F. COVID-19: ACE2centric infective disease? Hypertension. 2020;76:294–9.CrossRefPubMed
24.
go back to reference Verdecchia P, Cavallini C, Spanevello A, Angeli F. The pivotal link between ACE2 deficiency and SARS-CoV-2 infection. Eur J Intern Med. 2020;76:14–20.CrossRefPubMedPubMedCentral Verdecchia P, Cavallini C, Spanevello A, Angeli F. The pivotal link between ACE2 deficiency and SARS-CoV-2 infection. Eur J Intern Med. 2020;76:14–20.CrossRefPubMedPubMedCentral
25.
go back to reference Verdecchia P, Reboldi G, Cavallini C, Mazzotta G, Angeli F. ACE-inhibitors, angiotensin receptor blockers and severe acute respiratory syndrome caused by coronavirus. G Ital Cardiol (Rome). 2020;21:321–7.PubMed Verdecchia P, Reboldi G, Cavallini C, Mazzotta G, Angeli F. ACE-inhibitors, angiotensin receptor blockers and severe acute respiratory syndrome caused by coronavirus. G Ital Cardiol (Rome). 2020;21:321–7.PubMed
Metadata
Title
Complications of SARS-CoV-2 Infection During Cardiac Rehabilitation: A Case Series
Authors
Martina Zappa
Paolo Verdecchia
Andrea Andolina
Antonio Spanevello
Fabio Angeli
Publication date
15-07-2023
Publisher
Springer Healthcare
Published in
Cardiology and Therapy / Issue 3/2023
Print ISSN: 2193-8261
Electronic ISSN: 2193-6544
DOI
https://doi.org/10.1007/s40119-023-00325-6

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