Long COVID-19 and Postural Orthostatic Tachycardia Syndrome- Is Dysautonomia to Be Blamed?

Karan R Chadda,Ellen E Blakey,Kamalan Jeevaratnam,Christopher L -H Huang

doi:10.3389/fcvm.2022.860198

Abstract

While the increased arrhythmic tendency during acute COVID-19 infection is recognised, the long-term cardiac electrophysiological complications are less well known. There are a high number of patients reporting ongoing symptoms post-infection, termed long COVID. A recent hypothesis is that long COVID symptoms could be attributed to dysautonomia, defined as malfunction of the autonomic nervous system (ANS). The most prevalent cardiovascular dysautonomia amongst young people is postural orthostatic tachycardia syndrome (POTS). Numerous reports have described the development of POTS as part of long COVID. Possible underlying mechanisms, although not mutually exclusive or exhaustive, include hypovolaemia, neurotropism, inflammation and autoimmunity. Treatment options for POTS and other long COVID symptoms are currently limited. Future research studies should aim to elucidate the underlying mechanisms of dysautonomia to enable the development of targeted therapies. Furthermore, it is important to educate healthcare professionals to recognise complications and conditions arising from COVID-19, such as POTS, to allow prompt diagnosis and access to early treatment.

Highlights

The Hubei Integrated Chinese and Western Medicine hospital in Wuhan reported a clustered point-source outbreak of pneumonia, of unknown viral origin toward the end of December 2019
One mechanism could be via the development of autoantibodies which cross-react with autonomic ganglia as part of acute and long-term COVID-19 infection, and lead to dysautonomia and postural orthostatic tachycardia syndrome (POTS)
The role of the immune system in dysautonomia and long COVID-19 could have implications for treatment options as 75% of patients with POTS were positive for α3-AChR antibodies that could respond to immunotherapy [49]

Summary

INTRODUCTION

The Hubei Integrated Chinese and Western Medicine hospital in Wuhan reported a clustered point-source outbreak of pneumonia, of unknown viral origin toward the end of December 2019. An early study on patients hospitalised with COVID-19 in Wuhan showed the incidence for cardiac arrhythmic events was 17%, rising to 44% in those admitted to the intensive care unit [7]. While the increased arrhythmic tendency during acute infection is recognised, the long-term cardiac complications are less clear and remain to be reported. COVID-19 and Postural Orthostatic Tachycardia Syndrome on the associations between long COVID and tachycardia, postural orthostatic tachycardia syndrome (POTS), the potential aetiologies and a discussion on the future direction of research. This can present with symptoms of palpitations, chest pain and exercise or orthostatic intolerance [24]. Numerous reports have described the development of POTS as part of long COVID [19, 25–27] the aetiology remains debated

LONG COVID

Inflammation and Autoimmunity

MANAGEMENT OF POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME

Findings

CONCLUSION