Dysautonomia in COVID-19 patients: a narrative review on clinical course, diagnostic and therapeutic strategies
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2022-05-27
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Frontiers Media S.A.
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On March 11, 2020, the World Health Organization sounded the COVID-19 pandemic alarm. While efforts in the first few months focused on reducing the mortality of infected patients, there is increasing data on the effects of long-term infection (Post-COVID-19 condition). Among the different symptoms described after acute infection, those derived from autonomic dysfunction are especially frequent and limiting. To conduct a narrative review synthesizing current evidence of the signs and symptoms of dysautonomia in patients diagnosed with COVID-19, together with a compilation of available treatment guidelines. Autonomic dysfunction associated with SARS-CoV-2 infection occurs at different temporal stages. Some of the proposed pathophysiological mechanisms include direct tissue damage, immune dysregulation, hormonal disturbances, elevated cytokine levels, and persistent low-grade infection. Acute autonomic dysfunction has a direct impact on the mortality risk, given its repercussions on the respiratory, cardiovascular, and neurological systems. Iatrogenic autonomic dysfunction is a side effect caused by the drugs used and/or admission to the intensive care unit. Finally, late dysautonomia occurs in 2.5% of patients with Post-COVID-19 condition. While orthostatic hypotension and neurally-mediated syncope should be considered, postural orthostatic tachycardia syndrome (POTS) appears to be the most common autonomic phenotype among these patients. A review of diagnostic and treatment guidelines focused on each type of dysautonomic condition was done. Symptoms deriving from autonomic dysfunction involvement are common in those affected by COVID-19. These symptoms have a great impact on the quality of life both in the short and medium to long term. A better understanding of the pathophysiological mechanisms of Post-COVID manifestations that affect the autonomic nervous system, and targeted therapeutic management could help reduce the sequelae of COVID-19, especially if we act in the earliest phases of the disease.
Palabras clave
Diagnosis
Dysautonomia
Management
Orthostatic intolerance syndromes
Post-COVID-19 condition
POTS
Socioeconomic impact
Dysautonomia
Management
Orthostatic intolerance syndromes
Post-COVID-19 condition
POTS
Socioeconomic impact
Descripción
Materias
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Carmona-Torre, F., Mínguez-Olaondo, A., López-Bravo, A., Tijero, B., Grozeva, V., Walcker, M., Azkune-Galparsoro, H., López de Munain, A., Alcaide, A. B., Quiroga, J., del Pozo, J. L., & Gómez-Esteban, J. C. (2022). Dysautonomia in COVID-19 patients: a narrative review on clinical course, diagnostic and therapeutic strategies. Frontiers in Neurology, 13. https://doi.org/10.3389/FNEUR.2022.886609