Post-Acute Sequelae of COVID-19 and Cardiovascular Autonomic Dysfunction: What Do We Know?

Bisaccia, Giandomenico; Ricci, Fabrizio; Recce, Vittoria; Serio, Antonio; Iannetti, Gian Domenico; Chahal, Anwar; Ståhlberg, Marcus; Khanji, Mohammed Y; Fedorowski, Artur; Gallina, Sabina

doi:10.3390/jcdd8110156

Cited by 82 publications

(97 citation statements)

References 94 publications

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“…Postural orthostatic tachycardia syndrome may have an immunological cause. Many patients describe a postviral onset, [29][30][31][32] and 15%-20% of patients with POTS report a history of an autoimmune disorder such as Hashimoto thyroiditis, rheumatoid arthritis or Sjögren syndrome. 4 Recently, numerous cases of POTS 33 and other forms of sinus tachycardia (e.g., inappropriate sinus tachycardia) 34 after a SARS-CoV-2 infection have been reported.…”

Section: What Is the Pathophysiology Of Pots?mentioning

confidence: 99%

Diagnosis and management of postural orthostatic tachycardia syndrome

Raj

Fedorowski

Sheldon

2022

CMAJ

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Postural orthostatic tachycardia syndrome (POTS) is a chronic multisystem disorder; the cardinal feature is orthostatic tachycardia.• Patients with POTS have symptoms of orthostatic intolerance that improve with recumbence.• Girls and women are more commonly affected with POTS, beginning in puberty and through early adulthood.• Postural orthostatic tachycardia syndrome can lead to marked functional disability, often limiting work or schooling.• Treatments for POTS can improve symptoms and function, and can be initiated in primary care.

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Section: What Is the Pathophysiology Of Pots?mentioning

confidence: 99%

Diagnosis and management of postural orthostatic tachycardia syndrome

Raj

Fedorowski

Sheldon

2022

CMAJ

Self Cite

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“…In the United States, a study of 2 million COVID-19 survivors identified that 23% of convalescent patients had continued symptoms beyond four weeks, and, as also found in the UK ( 16 ), represented all age groups and included patients whose initial SARS-CoV-2 infection was asymptomatic or mildly symptomatic ( 15 , 17 , 18 ). Symptoms related to cardiovascular autonomic dysfunction seem to be common in patients affected by long COVID syndrome ( 19 ). Moreover, pre-existing cardiovascular risk factors, socio/economic disparities, and comorbidities concur in amplifying the adverse, long-term consequences of COVID-19 (syndemic) ( 20 – 23 ).…”

Section: Introductionmentioning

confidence: 99%

The Additive Value of Cardiovascular Magnetic Resonance in Convalescent COVID-19 Patients

Borlotti¹,

Thomaides-Brears²,

Georgiopoulos

et al. 2022

Front. Cardiovasc. Med.

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In COVID-19 the development of severe viral pneumonia that is coupled with systemic inflammatory response triggers multi-organ failure and is of major concern. Cardiac involvement occurs in nearly 60% of patients with pre-existing cardiovascular conditions and heralds worse clinical outcome. Diagnoses carried out in the acute phase of COVID-19 rely upon increased levels of circulating cardiac injury biomarkers and transthoracic echocardiography. These diagnostics, however, were unable to pinpoint the mechanisms of cardiac injury in COVID-19 patients. Identifying the main features of cardiac injury remains an urgent yet unmet need in cardiology, given the potential clinical consequences. Cardiovascular magnetic resonance (CMR) provides an unparalleled opportunity to gain a deeper insight into myocardial injury given its unique ability to interrogate the properties of myocardial tissue. This endeavor is particularly important in convalescent COVID-19 patients as many continue to experience chest pain, palpitations, dyspnea and exertional fatigue, six or more months after the acute illness. This review will provide a critical appraisal of research on cardiovascular damage in convalescent adult COVID-19 patients with an emphasis on the use of CMR and its value to our understanding of organ damage.

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“…44 Since the onset of the COVID-19 pandemic, an increasing number of case reports about the occurrence of POTS secondary to a COVID-19 infection have emerged. [24][25][26][27][28][29][30] Several hypotheses about possible pathomechanisms of POTS or dysautonomia in general after COVID-19 infection have been proposed: imbalance of the renin-angiotensin-aldosterone system, 26,29 brainstem involvement, 43,45,46 autoreactivity to antibodies against SARS-CoV-2, 25,43,47 dyshomeostasis of immune response 42,44 and denervation of peripheral sympathetic nerve fibers. 26,43,42 This study has some limitations.…”

Section: Muscle Painmentioning

confidence: 99%

Tolerability of COVID-19 mRNA vaccines in patients with postural tachycardia syndrome: a cross-sectional study

et al. 2022

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Background: Postural tachycardia syndrome (POTS) is a form of autonomic dysregulation. There is increasing evidence that the etiology may be immune-mediated in a subgroup of patients. Patients with POTS often experience an exacerbation of their symptoms associated with (viral) infections and often fear the same symptom aggravation after vaccination. In this report we describe the tolerability of messenger ribonucleic acid (mRNA) vaccines against coronavirus disease 19 (COVID-19) and the consequences of a COVID-19 infection on POTS symptoms in our cohort of patients with neuropathic POTS. Methods: We conducted a standardized, checklist-based interview with 23 patients and recorded the acute side effects of mRNA vaccination, acute symptoms of COVID-19 infection as well as the effects of vaccination and COVID-19 infection on POTS symptoms. Results: Of all included patients, 20 patients received two mRNA vaccines without having had a previous COVID-19 infection, and five patients in total had suffered a COVID-19 infection. Of these, three had COVID-19 without and two after being vaccinated. No increased frequency of side effects after both doses of mRNA vaccines was observed. Six patients reported a mild and short-term aggravation of their POTS symptoms beyond the duration of acute vaccine side effects. All five patients who suffered a COVID-19 infection subsequently reported a pronounced and persistent exacerbation of POTS symptoms. Conclusions: Our observations suggest that mRNA vaccines are not associated with a higher frequency of acute side effects in patients with POTS. Symptom exacerbation as a consequence of mRNA vaccination seems to be less frequent and of shorter duration compared to patients who suffered a COVID-19 infection.

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Post-Acute Sequelae of COVID-19 and Cardiovascular Autonomic Dysfunction: What Do We Know?

Cited by 82 publications

References 94 publications

Diagnosis and management of postural orthostatic tachycardia syndrome

Diagnosis and management of postural orthostatic tachycardia syndrome

The Additive Value of Cardiovascular Magnetic Resonance in Convalescent COVID-19 Patients

Tolerability of COVID-19 mRNA vaccines in patients with postural tachycardia syndrome: a cross-sectional study

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