COVID-19 and postural tachycardia syndrome: a case series

William H Parker; Rohit Moudgil; Robert G Wilson; Adriano R Tonelli; Kenneth A Mayuga; Tamanna K Singh

doi:10.1093/ehjcr/ytab325

COVID-19 and postural tachycardia syndrome: a case series

Eur Heart J Case Rep. 2021 Dec 30;5(12):ytab325. doi: 10.1093/ehjcr/ytab325. eCollection 2021 Dec.

Authors

William H Parker¹, Rohit Moudgil¹, Robert G Wilson², Adriano R Tonelli³, Kenneth A Mayuga¹, Tamanna K Singh¹

Affiliations

¹ Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave, Desk J2-4, Cleveland, OH 44195, USA.
² Neuromuscular Center, Neurology Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA.
³ Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA.

Abstract

Background: Postural tachycardia syndrome (PTS) is a novel identified sequela of COVID-19 infection. This observational study describes clinical presentation, testing, and treatment response in seven patients diagnosed with PTS following COVID-19 infection.

Case summary: A total of seven active patients (three collegiate athletes, one recreational athlete, two registered nurses, one hospitality employee), age 24 ± 6 years, and six females were followed for a mean of 152 ± 105 days after contracting COVID-19. Tilt table was performed to establish the diagnosis. The most common presenting symptoms were palpitations (7/7), dyspnoea (6/7), and gastrointestinal complaints (5/7). One patient required hospitalization for symptom management. The mean latency of PTS onset following COVID-19 was 21 ± 15 days. Electrocardiograms (ECGs) demonstrated sinus rhythm in all patients, one with resting sinus tachycardia. Echocardiogram demonstrated normal systolic and diastolic left ventricular function in all patients. On tilt table testing, baseline heart rate (HR) was 72 ± 12 with maximum HR reaching 136 ± 13. Six of seven patients failed to respond to supportive therapy alone, and two patients failed medical management with ivabradine, midodrine, and/or metoprolol. Of three severely symptomatic patients, two demonstrated some degree of clinical recovery with intravenous immunoglobulin (IVIG).

Discussion: This novel case series describes the development of PTS in the context of COVID-19 infection. Severity of symptoms and response to treatment was heterogeneous. Interestingly, patients were poorly responsive to traditional PTS treatments, but IVIG showed potential as a possible therapeutic strategy for refractory PTS in two patients, particularly following COVID-19 infection.

Keywords: Autonomic dysfunction; Case series; Intravenous immunoglobulin; Postural tachycardia syndrome; Severe acute respiratory syndrome coronavirus 2019 (COVID-19).

Publication types

Case Reports