Carmona de la Torre, FranciscoMínguez Olaondo, AneLópez Bravo, AlbaTijero Merino, BeatrizGrozeva, VasselinaWalcker, MichaelaAzkune, HarkaitzLópez de Munain Arregui, AdolfoAlcaide, Ana BelénQuiroga Vila, Jorge AugustoPozo, José Luis delGómez Esteban, Juan Carlos2025-10-162025-10-162022-05-27Carmona-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.2022.88660910.3389/FNEUR.2022.886609https://hdl.handle.net/20.500.14454/3991On 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.eng© 2022 Carmona-Torre, Mínguez-Olaondo, López-Bravo, Tijero, Grozeva, Walcker, Azkune-Galparsoro, López de Munain, Alcaide, Quiroga, del Pozo and Gómez-EstebanDiagnosisDysautonomiaManagementOrthostatic intolerance syndromesPost-COVID-19 conditionPOTSSocioeconomic impactreview article2025-10-161664-2295