Abstract
Post-acute sequelae of SARS-CoV-2 (PASC), or long COVID syndrome, is emerging as a major health issue in patients with previous SARS-CoV-2 infection. Symptoms commonly experienced by patients include fatigue, palpitations, chest pain, dyspnea, reduced exercise tolerance, and “brain fog”. Additionally, symptoms of orthostatic intolerance and syncope suggest the involvement of the autonomic nervous system. Signs of cardiovascular autonomic dysfunction appear to be common in PASC and are similar to those observed in postural orthostatic tachycardia syndrome and inappropriate sinus tachycardia. In this review, we report on the epidemiology of PASC, discuss current evidence and possible mechanisms underpinning the dysregulation of the autonomic nervous system, and suggest nonpharmacological and pharmacological interventions to treat and relieve symptoms of PASC-associated dysautonomia.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic was declared a global health emergency in early 2020 and has since affected over 217 million people worldwide, causing the death of more than 4.5 million by 1 September 2021 [1]
Beyond appropriate sinus tachycardia, which comprises both physiological and pathologic causes of increased heart rate, a possible explanation for palpitations and fatigue in COVID-19 survivors is postural orthostatic tachycardia syndrome (POTS), which is a dysautonomia characterized by an excess in heart rate increase on standing and orthostatic intolerance [49]; it is more frequent in females (80% of cases), and the young
The American Autonomic Society (AAS) stated that most Post-acute sequelae of severe acute respiratory syndrome (SARS)-CoV-2 (PASC) symptoms can be suggestive of POTS when the patient suffers from excessive orthostatic tachycardia, and that further, in-depth studies are needed to elucidate the duration of post-COVID cardiovascular autonomic dysfunction (CVAD), its underlying pathophysiology, and optimum treatment
Summary
The coronavirus disease 2019 (COVID-19) pandemic was declared a global health emergency in early 2020 and has since affected over 217 million people worldwide, causing the death of more than 4.5 million by 1 September 2021 [1]. The long-term effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are largely unknown, yet beyond the first 30 days of illness, COVID-19 survivors are reportedly at higher risk of death, health care resource utilization, and exhibit a broad array of pulmonary and extrapulmonary clinical manifestations, including neurologic and cardiologic disorders, and a spectrum of symptoms related to poor general wellbeing, even after the resolution of the acute illness [2]. Since the publication of preliminary reports concerning post-COVID syndrome, a plethora of definitions have been proposed. Concerns have been raised that PASC might be the clinical expression of COVID-related cardiovascular autonomic dysfunction [9], with some overlapping features suggestive of postural orthostatic tachycardia syndrome (POTS) [10]. We (1) discuss the most recent evidence on PASC-related dysautonomia and (2) provide possible pathways leading to cardiovascular autonomic dysfunction (CVAD) after SARS-CoV-2 infection
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