Post-Acute Sequelae of COVID-19 and Cardiovascular Autonomic Dysfunction: What Do We Know?

Giandomenico Bisaccia; Fabrizio Ricci; Vittoria Recce; Antonio Serio; Giovanni Iannetti; Anwar A Chahal; Marcus Ståhlberg; Mohammed Yunus Khanji; Artur Fedorowski; Sabina Gallina

doi:10.3390/jcdd8110156

Post-Acute Sequelae of COVID-19 and Cardiovascular Autonomic Dysfunction: What Do We Know?

J Cardiovasc Dev Dis. 2021 Nov 15;8(11):156. doi: 10.3390/jcdd8110156.

Authors

Giandomenico Bisaccia¹, Fabrizio Ricci^{1

2

3}, Vittoria Recce¹, Antonio Serio¹, Giovanni Iannetti⁴, Anwar A Chahal^{5

6

7

8}, Marcus Ståhlberg⁹, Mohammed Yunus Khanji^{8

10

11}, Artur Fedorowski^{2

9}, Sabina Gallina¹

Affiliations

¹ Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, "G. d'Annunzio" University of Chieti-Pescara, Via Luigi Polacchi, 66100 Chieti, Italy.
² Department of Clinical Sciences, Lund University, 20502 Malmö, Sweden.
³ Casa di Cura Villa Serena, Città Sant'Angelo, 66013 Pescara, Italy.
⁴ Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy.
⁵ Center for Inherited Cardiovascular Diseases, WellSpan Health, 140 North Pointe Boulevard, Lancaster, PA 17601, USA.
⁶ Division of Cardiology, Department of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
⁷ Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
⁸ Barts Heart Centre, Barts Health NHS Trust, London EC1A 7BE, UK.
⁹ Cardiology, Heart, Vascular and Neuro Theme, Karolinska University Hospital, Department of Medicine, Solna, Karolinska Institutet, 17177 Stockholm, Sweden.
¹⁰ Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, London E13 8SL, UK.
¹¹ NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London EC1A 7BE, UK.

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.

Keywords: COVID-19; PASC; autoimmunity; cardiovascular autonomic dysfunction; long COVID syndrome; post-acute sequelae; postural orthostatic tachycardia.

Publication types

Review