Figure 2.

Framework for Evaluating and Managing Cardiovascular Sequelae of COVID-19 in Adults

Gold and purple boxes = COVID-19 symptoms. Orange boxes = cardiac testing. Red and blue boxes = diagnoses (sequelae). ∗Includes elevated cTn; ECG with diffuse T-wave inversion, ST-segment elevation without reciprocal ST-segment depression, and/or prolongation of the QRS complex duration; and echocardiogram with ventricular wall motion abnormalities, often in a noncoronary distribution, and/or abnormal ventricular strain. †Informed by the presentation and may include coronary angiography for suspected acute coronary syndrome or CT pulmonary angiography for suspected pulmonary embolism (see Figure 3). ‡Includes other laboratory testing (eg, complete blood count, basic metabolic panel, C-reactive protein), an ambulatory rhythm monitor, a chest X-ray or CT imaging, and pulmonary function tests, along with additional testing for suspected PASC-CVD or PASC-CVS (see Figure 7). §For patients with myocarditis, medical therapy may include immunosuppressive drugs (eg, corticosteroids); for patients with pericardial involvement, medical therapy may include nonsteroidal anti-inflammatory drugs, colchicine, and corticosteroids (see Figure 3). ‖See Figure 7. ¶For patients with PASC-CVS, empiric medical therapy may include a beta-blocker, a non-dihydropyridine calcium-channel blocker, ivabradine, fludrocortisone, and/or midodrine. #Includes maximal-effort exercise testing and/or an ambulatory rhythm monitor (see Figure 9). CMR = cardiac magnetic resonance imaging; COVID-19 = novel coronavirus disease 2019; CT = computed tomography; cTn = cardiac troponin; ECG = electrocardiogram, MCS = mechanical circulatory support; PASC = post-acute sequelae of SARS-CoV-2 infection; PASC-CVD = PASC-Cardiovascular Disease; PASC-CVS = PASC-Cardiovascular Syndrome; RTP = return to play; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.