Post-acute sequelae of SARS-CoV-2 syndrome presenting as postural orthostatic tachycardia syndrome

Diekman, Sarah; Chung, Tae Hwan

doi:10.15441/ceem.22.409

Cited by 2 publications

(2 citation statements)

References 37 publications

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“…Notably, the magnitude of heart rate variations observed during the active standing test is considerably smaller when compared to those observed during the head-up tilt test. This disparity can be attributed to the contraction of the gastrocnemius muscle during the active standing test, which leads to an increased cardiac preload ( 58 ). Nitroglycerin provocation is a standard part of the head-up tilt test protocol for assessing vasovagal syncope that increases the sensitivity for orthostatic intolerance symptoms but may lower the specificity for the reproduction of clinical symptoms ( 59 , 60 ).…”

Section: Diagnosismentioning

confidence: 99%

Postural orthostatic tachycardia syndrome and other related dysautonomic disorders after SARS-CoV-2 infection and after COVID-19 messenger RNA vaccination

Gómez-Moyano,

Rodríguez-Capitán,

Gaitán Román

et al. 2023

Front. Neurol.

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The COVID-19 pandemic has caused a challenge for our society due to the post-acute sequelae of the disease. Persistent symptoms and long-term multiorgan complications, known as post-acute COVID-19 syndrome, can occur beyond 4 weeks from the onset of the COVID-19 infection. Postural orthostatic tachycardia syndrome (POTS) is considered a variety of dysautonomia, which is characterized by chronic symptoms that occur with standing and a sustained increase in heart rate, without orthostatic hypotension. POTS can lead to debilitating symptoms, significant disability, and impaired quality of life. In this narrative review, the etiopathogenic basis, epidemiology, clinical manifestations, diagnosis, treatment, prognosis, and socioeconomic impact of POTS, as well as other related dysautonomic disorders, after COVID-19 infection and SARS-CoV-2 postvaccination, were discussed. After a search conducted in March 2023, a total of 89 relevant articles were selected from the PubMed, Google Scholar, and Web of Science databases. The review highlights the importance of recognizing and managing POTS after COVID-19 infection and vaccination, and the approach to autonomic disorders should be known by all specialists in different medical areas. The diagnosis of POTS requires a comprehensive clinical assessment, including a detailed medical history, physical examination, orthostatic vital signs, and autonomic function tests. The treatment of POTS after COVID-19 infection or vaccination is mainly focused on lifestyle modifications, such as increased fluid and salt intake, exercise, and graduated compression stockings. Pharmacotherapy, such as beta-blockers, fludrocortisone, midodrine, and ivabradine, may also be used in selected cases. Further research is needed to understand the underlying mechanisms, risk factors, and optimal treatment strategies for this complication.

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Section: Diagnosismentioning

confidence: 99%

Postural orthostatic tachycardia syndrome and other related dysautonomic disorders after SARS-CoV-2 infection and after COVID-19 messenger RNA vaccination

Gómez-Moyano,

Rodríguez-Capitán,

Gaitán Román

et al. 2023

Front. Neurol.

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“…Autoimmune disorders and Autoimmunity Some strong associations [16,[22][23][24][25][26] Cognitive function Large amount of literature; improved by plasma exchange [27] [27-30] Fatigue [31][32][33][34][35][36][37][38] HPV or other antiviral vaccination An example of induction by a viral protein [39][40][41][42][43][44][45] but cf. [46] Inflammation [47] Irritable bowel disease [48] Long COVID A very common occurrence and a focus of our interest [16][17][18][19][20][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67]<...…”

Section: Introduction Orthostasis Orthostatic Intolerance and Potsmentioning

confidence: 99%

Possible Role of Fibrinaloid Microclots in Postural Orthostatic Tachycardia Syndrome (POTS): Focus on Long COVID

Kell,

Khan,

Kane

et al. 2024

JPM

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Postural orthostatic tachycardia syndrome (POTS) is a common accompaniment of a variety of chronic, inflammatory diseases, including long COVID, as are small, insoluble, ‘fibrinaloid’ microclots. We here develop the argument, with accompanying evidence, that fibrinaloid microclots, through their ability to block the flow of blood through microcapillaries and thus cause tissue hypoxia, are not simply correlated with but in fact, by preceding it, may be a chief intermediary cause of POTS, in which tachycardia is simply the body’s exaggerated ‘physiological’ response to hypoxia. Similar reasoning accounts for the symptoms bundled under the term ‘fatigue’. Amyloids are known to be membrane disruptors, and when their targets are nerve membranes, this can explain neurotoxicity and hence the autonomic nervous system dysfunction that contributes to POTS. Taken together as a system view, we indicate that fibrinaloid microclots can serve to link POTS and fatigue in long COVID in a manner that is at once both mechanistic and explanatory. This has clear implications for the treatment of such diseases.

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Post-acute sequelae of SARS-CoV-2 syndrome presenting as postural orthostatic tachycardia syndrome

Abstract: Post-acute sequelae of SARS-CoV-2 (PASC) syndrome presenting as postural orthostatic tachycardia syndrome (POTS)

Cited by 2 publications

References 37 publications

Postural orthostatic tachycardia syndrome and other related dysautonomic disorders after SARS-CoV-2 infection and after COVID-19 messenger RNA vaccination

Postural orthostatic tachycardia syndrome and other related dysautonomic disorders after SARS-CoV-2 infection and after COVID-19 messenger RNA vaccination

Possible Role of Fibrinaloid Microclots in Postural Orthostatic Tachycardia Syndrome (POTS): Focus on Long COVID

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