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

Abstract

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.

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

“…Familial (monogenic) Lesion in the IKBKAP gene [118] Long COVID [57,60,62,63,67,76,[119][120][121][122][123][124] Multiple sclerosis [125,126] Myalgic encephalomyelitis/chronic fatigue syndrome [76,82,119,[127][128][129][130][131][132][133] Parkinson's disease [134]…”

“…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]<...…”

The risks of autoimmune- and inflammatory post-acute COVID-19 conditions: a network cohort study in six European countries, the US, and Korea

“…[4,5] On one hand, the close interplay between the immune system and the autonomic nervous system underscores the link between COVID-19 and conditions like postural orthostatic tachycardia syndrome (POTS). [6][7][8][9][10][11][12] On the other hand, the precise link between COVID-19 and myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) is still being elucidated.…”