High Incidence of Autonomic Dysfunction and Postural Orthostatic Tachycardia Syndrome in Patients with Long COVID: Implications for Management and Health Care Planning

Seeley, Marie-Claire; Gallagher, C.; Ong, Eric; Langdon, Amy; Chieng, Jenny Hui Ling; Bailey, Danielle; Page, Amanda J.; Lim, H.; Lau, Dennis H.

doi:10.1016/j.amjmed.2023.06.010

Cited by 18 publications

(10 citation statements)

References 30 publications

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“…Seeley et al 33 Several patients in this study had visited up to four medical facilities prior to our clinic and had not been diagnosed with POTS complications. Shaw et al 31 reported that POTS diagnosis took 2 years and involved seven doctors.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of long COVID complicated by postural orthostatic tachycardia syndrome—Case series research

Tsuchida,

Ishibashi,

Inoue

et al. 2023

J of Gen and Family Med

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BackgroundCoronavirus disease 2019 (COVID‐19) sequelae, also known as long COVID, can present with various symptoms. Among these symptoms, autonomic dysregulation, particularly postural orthostatic tachycardia syndrome (POTS), should be evaluated. However, previous studies on the treatment of POTS complicated by COVID‐19 are lacking. Therefore, this study aimed to investigate the treatment course of long COVID complicated by POTS.MethodsThe medical records of patients who complained of fatigue and met the criteria for POTS diagnosis were reviewed. We evaluated the treatment days, methods and changes in fatigue score, changes in heart rate on the Schellong test, and social situation at the first and last visits.ResultsThirty‐two patients with long COVID complicated by POTS were followed up (16 males; median age: 28 years). The follow‐up period was 159 days, and the interval between COVID‐19 onset and initial hospital attendance was 97 days. Some patients responded to β‐blocker therapy. Many patients had psychiatric symptoms that required psychiatric intervention and selective serotonin reuptake inhibitor prescription. Changes in heart rate, performance status, and employment/education status improved from the first to the last visit. These outcomes were believed to be because of the effects of various treatment interventions and spontaneous improvements.ConclusionsOur study suggests that the condition of 94% of patients with POTS complicated by long COVID will improve within 159 days. Therefore, POTS evaluation should be considered when patients with long COVID complain of fatigue, and attention should be paid to psychological symptoms and the social context.

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Section: Discussionmentioning

confidence: 99%

“…Seeley et al. 33 conducted a detailed autonomic evaluation involving 33 patients with long COVID, 33 with POTS unassociated with COVID‐19, and 33 healthy individuals. Of the 33 patients with long COVID, 26 met the POTS diagnosis criteria.…”

Section: Discussionmentioning

confidence: 99%

Treatment of long COVID complicated by postural orthostatic tachycardia syndrome—Case series research

Tsuchida,

Ishibashi,

Inoue

et al. 2023

J of Gen and Family Med

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“…Among those complaining of dyspnea, POTS (50), asthma or chronic obstructive pulmonary disease (COPD) (7), and organizing pneumonia (3) were present as complications. Among patients complaining of cough, postinfectious cough or cough-variant asthma (12), gastroesophageal re ux disease (10), and bronchial asthma (4) were present as complications. Among patients who complained of headaches, migraine (31) and tension-type headaches (18) were present as complications.…”

Section: Relationship Between Initial Symptoms and Complicationsmentioning

confidence: 99%

“…Several complications that exist in the background of long COVID have been reported. Seeley et al showed that 79% of patients with long COVID meet the diagnostic criteria of postural orthostatic tachycardia syndrome (POTS) [10]. Headache, which often exhibits phenotypes such as migraines and tension-type headaches, has also been reported to be common, and psychiatric disorders have been reported to newly occur in 16% of those with long COVID [11,12].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of diseases complicating long COVID: A retrospective chart review

Tsuchida,

Hirose,

Fujii

et al. 2024

Preprint

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Purpose Evidence for the pathogenesis and treatment of post-acute coronavirus disease 2019 (COVID-19) (long COVID) is lacking. As long COVID symptoms are predicted to have an impact on the global economy, clarification of the pathogenesis is urgently needed. Our experiences indicated that some symptoms were complicated by diseases established before the COVID-19 pandemic. Methods Using a retrospective, cross-sectional study, we aimed to evaluate the diseases complicating long COVID. Using the medical records of patients with confirmed severe acute respiratory syndrome coronavirus 2 infection exhibiting residual symptoms lasting ≥ 60 days post-infection who visited our clinic in January 2021–February 2023, we investigated the symptoms and diseases observed. We identified diseases that occurred after COVID-19 infection and excluded those that were exacerbations of existing diseases. Results: During the first visit, the most common symptoms reported in a total of 798 patients were fatigue (523 patients), anxiety (349 patients), and lack of motivation (344 patients). Complicating diseases were observed in 452 patients (57%). There were 115, 65, and 60 patients with postural tachycardia syndrome, postural syndrome without tachycardia, and mood disorders, respectively. Some diseases requiring immediate treatment included pulmonary thromboembolism, purulent shoulder arthritis, cerebellopontine angle tumors, myasthenia gravis, and cervical myelopathy. Conclusion All symptoms that occur after COVID-19 infection should not be treated as long COVID. Similar to normal medical treatment, a list of differential diagnoses should be maintained based on symptoms to obtain definitive diagnoses.

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“…Autoantibodies may be inflammatory and result in neuro-inflammation; however, they may also result in molecular mimicry or even negate chemokine responses [112,113]. Several of these antibodies can be related to brainstem injury and may contribute to POTS in long COVID [89,[114][115][116][117]. Autoantibodies recognizing G protein-coupled receptors are one mechanism thought to be important for POTS and antibodies specific to the beta adreno-receptor have been reported in patients with long COVID [118].…”

Section: Neuroimmunology Of Long Covidmentioning

confidence: 99%

Immune Mechanisms Underpinning Long COVID: Collegium Internationale Allergologicum Update 2024

Untersmayr,

Venter,

Smith

et al. 2024

Int Arch Allergy Immunol

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Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can result in a prolonged multisystem disorder termed long COVID, which may affect up to 10% of people following coronavirus disease 2019 (COVID-19). It is currently unclear why certain individuals do not fully recover following SARS-CoV-2 infection. Summary: In this review, we examine immunological mechanisms that may underpin the pathophysiology of long COVID. These mechanisms include an inappropriate immune response to acute SARS-CoV-2 infection, immune cell exhaustion, immune cell metabolic reprogramming, a persistent SARS-CoV-2 reservoir, reactivation of other viruses, inflammatory responses impacting the central nervous system, autoimmunity, microbiome dysbiosis, and dietary factors. Key Messages: Unfortunately, the currently available diagnostic and treatment options for long COVID are inadequate, and more clinical trials are needed that match experimental interventions to underlying immunological mechanisms.

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High Incidence of Autonomic Dysfunction and Postural Orthostatic Tachycardia Syndrome in Patients with Long COVID: Implications for Management and Health Care Planning

Cited by 18 publications

References 30 publications

Treatment of long COVID complicated by postural orthostatic tachycardia syndrome—Case series research

Treatment of long COVID complicated by postural orthostatic tachycardia syndrome—Case series research

Evaluation of diseases complicating long COVID: A retrospective chart review

Immune Mechanisms Underpinning Long COVID: Collegium Internationale Allergologicum Update 2024

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