Cardiovascular Sequelae of Long COVID: A Systematic Review of Clinical Manifestations, Biomarkers, and Management Strategies

Background: Long COVID, or post–COVID-19 condition, refers to persisting or new symptoms after acute SARS-CoV-2 infection, often beyond 3 months​. Cardiovascular sequelae are an important subset of long COVID, ranging from mild symptoms to serious complications. We aimed to systematically review the cardiovascular manifestations, associated biomarkers, and management strategies in adults with long COVID. Methods: We searched major databases for peer-reviewed studies (2020–2024) on long COVID in adults, focusing on cardiovascular complications, biomarkers (troponin, natriuretic peptides, C-reactive protein, D-dimer), and management. The review followed PRISMA guidelines with a predefined protocol (PROSPERO registration drafted). Results: We included >100 studies encompassing observational cohorts, case series, and clinical trials. Long COVID is associated with a spectrum of cardiovascular complications including myocarditis, pericarditis, arrhythmias (e.g. atrial fibrillation, sinus tachycardia, POTS), thromboembolic events (venous thromboembolism, stroke, myocardial infarction), and new-onset heart failure​. Many patients report symptoms such as chest pain, palpitations, and dyspnea, though objective cardiac findings are absent in a majority​ Key biomarkers often remain normal in mild cases, but subsets show persistent inflammatory and thrombotic activation (elevated CRP, D-dimer)​ or cardiac injury markers (troponin)​ Management is multidisciplinary and symptom-driven: myocarditis and heart failure are managed with guideline-directed therapy (and immunosuppression in severe cases), arrhythmias and POTS with lifestyle modification and medications, and thrombotic risks with appropriate anticoagulation​ Rehabilitation, risk factor control, and prevention (e.g. vaccination) are emphasized​ Conclusion: Long COVID can lead to diverse cardiovascular complications in adults, underpinned by persistent inflammation and coagulopathy. While serious cardiac events are relatively infrequent, even mild sequelae can impair quality of life. Careful evaluation (to distinguish functional syndromes from organ damage) and individualized management strategies are required. Ongoing research is needed to better predict, prevent, and treat the cardiovascular manifestations of long COVID.