Dysautonomia in COVID-19 patients: a narrative review on clinical course, diagnostic and therapeutic strategies

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dc.contributor.authorCarmona de la Torre, Francisco
dc.contributor.authorMínguez Olaondo, Ane
dc.contributor.authorLópez Bravo, Alba
dc.contributor.authorTijero Merino, Beatriz
dc.contributor.authorGrozeva, Vasselina
dc.contributor.authorWalcker, Michaela
dc.contributor.authorAzkune, Harkaitz
dc.contributor.authorLópez de Munain Arregui, Adolfo
dc.contributor.authorAlcaide, Ana Belén
dc.contributor.authorQuiroga Vila, Jorge Augusto
dc.contributor.authorPozo, José Luis del
dc.contributor.authorGómez Esteban, Juan Carlos
dc.date.accessioned2025-10-16T12:41:17Z
dc.date.available2025-10-16T12:41:17Z
dc.date.issued2022-05-27
dc.date.updated2025-10-16T12:41:17Z
dc.description.abstractOn 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.en
dc.identifier.citationCarmona-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
dc.identifier.doi10.3389/FNEUR.2022.886609
dc.identifier.eissn1664-2295
dc.identifier.urihttps://hdl.handle.net/20.500.14454/3991
dc.language.isoeng
dc.publisherFrontiers Media S.A.
dc.rights© 2022 Carmona-Torre, Mínguez-Olaondo, López-Bravo, Tijero, Grozeva, Walcker, Azkune-Galparsoro, López de Munain, Alcaide, Quiroga, del Pozo and Gómez-Esteban
dc.subject.otherDiagnosis
dc.subject.otherDysautonomia
dc.subject.otherManagement
dc.subject.otherOrthostatic intolerance syndromes
dc.subject.otherPost-COVID-19 condition
dc.subject.otherPOTS
dc.subject.otherSocioeconomic impact
dc.titleDysautonomia in COVID-19 patients: a narrative review on clinical course, diagnostic and therapeutic strategiesen
dc.typereview article
dcterms.accessRightsopen access
oaire.citation.titleFrontiers in Neurology
oaire.citation.volume13
oaire.licenseConditionhttps://creativecommons.org/licenses/by/4.0/
oaire.versionVoR
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