Cleveland Clinic journal of medicine
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An estimated 10% of COVID-19 survivors continue to experience symptoms several weeks to months after the appearance of initial symptoms, a condition termed post-acute sequelae of SARS-CoV-2 infection (PASC). These patients, also called "long-haulers," most commonly report protracted symptoms of fatigue, cough, dyspnea, chest tightness, difficulty concentrating, arthralgia, olfactory dysfunction, and headache. While age, comorbid medical conditions, and COVID-19 severity are suspected risk factors for PASC, young and previously healthy individuals with mild COVID-19 are also at risk. Recognition of symptoms, evaluation, supportive treatment, and attention to medical comorbidities are the cornerstones of medical management.
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Ischemia and no obstructive coronary artery disease (INOCA) is an increasingly recognized cause of angina, and it is more commonly diagnosed in women. Coronary microvascular dysfunction (CMD), or the abnormal dilation and constriction of the small vessels of the heart, is the underlying cause of INOCA in one-half of cases. This review discusses coronary microvascular pathophysiology, considerations for invasive coronary function testing and noninvasive diagnostic modalities, implications for management, and remaining knowledge gaps.
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Editorial Comment
Fungus among us: A poster child for diagnostic stewardship.