TABLE 1.

Recommendations for the assessment of cardiovascular complications in patients with PASC

#	Cardiovascular complications assessment statement
1a	Patient History: A full patient history should be performed to include review of predisposing comorbidities, prior cardiovascular events, severity of the initial COVID‐19 illness—mild, moderate, severe, including relevant hospitalization and care in the intensive care unit (ICU), need for ventilator, extra‐corporeal membrane oxygenation (ECMO) etc., and timeline of symptom evolution. Additional components of the patient history should address: Most common new or worsening cardiac symptoms: chest pain, palpitations, shortness of breath, near‐or syncopal episodes, exercise intolerance, fatigue, Studies conducted to date: labs, electrocardiogram, echocardiogram , chest imaging, other cardiac work‐up if done (cardiac catheterization, cardiac magnetic resonance imaging, etc.), Medication history—Evaluate for medications that may impact symptoms, signs or assessment parameters (ie, medications with anti‐arrhythmic, diuretic or vaso‐active impact).
1b	Patient History: Symptoms should be characterized to understand contributing factors that limit activity including onset (new, acute or chronic), frequency, intensity, aggravating and alleviating factors, etc.
2a	Initial Evaluation: Clinicians should conduct a thorough examination of the cardiovascular system including routine vital signs (heart rate [HR], blood pressure [BP], pulse oximetry), auscultation of heart and lungs, peripheral pulses and bruits, and signs of volume overload.
2b	Initial Evaluation: For individuals reporting dizziness, lightheadedness, and syncope/presyncope clinicians should further characterize the perceived dizziness (lightheadedness vs. room spinning sensation) and differentiate between central or peripheral etiologies which warrant specialist referral.
2c	Initial Evaluation: To differentiate cardiovascular from autonomic dysfunction, check for orthostatic blood pressure and heart rate response in supine and standing position. If abnormal or symptoms are concerning for autonomic dysfunction, continue evaluation as per the autonomic dysfunction guideline including a 10‐min active stand test. (Blitshteyn S, Abramoff B, Azola A, et al. Multi‐Disciplinary Collaborative Consensus Guidance Statement on the Assessment and Treatment of Autonomic Dysfunction in Patients with Post‐Acute Sequelae of SARS‐CoV‐2 Infection (PASC): submitted to PM&R, under review)
3	Order basic laboratory work‐up in individuals with cardiac symptoms, or those without lab work‐up in the 3 months prior to the visit. Consider: complete blood count, basic metabolic panel, troponin level (preferably high‐sensitivity), brain natriuretic peptide or N‐terminal pro b‐type natriuretic peptide, D‐dimer, C‐reactive protein and erythrocyte sedimentation rate, lipid panel. Further laboratory work‐up may be considered based on the results of the basic tests or if there is concern for specific cardiac conditions.
4	Clinicians should consider ordering electrocardiogram, echocardiogram, and/or ambulatory cardiac monitoring. Holter for symptoms occurring every day. 14‐day monitor (e.g., Ziopatch) for symptoms occurring every few days Event monitor (looping or non‐looping, mobile cardiac telemetry) for infrequent symptoms.
5	Where diagnosis is uncertain or symptoms are progressing or severe consider referral to a cardiologist for more detailed assessment (computed tomography of the chest, cardiac magnetic resonance imaging, cardiac stress testing, cardiopulmonary exercise testing).
6	On initial evaluation, obtain standardized measures of activity performance to compare to normal control values and to guide the initial activity prescription. Repeat the standardized measures of activity performance at follow‐up visits to quantify functional changes and guide progression of the activity prescription.

Abbreviation: PASC, postacute sequelae of SARS‐CoV‐2 infection.