Dysautonomia in COVID-19 patients: a narrative review on clinical course, diagnostic and therapeutic strategies
Keywords: 
Dysautonomia
Post-COVID-19 condition
Socioeconomic impact
Orthostatic intolerance syndromes
Diagnosis
Management
Orthostatic tachycardia syndrome
Autoantibodies
Dysfunction
Management
POTS
Issue Date: 
2022
ISSN: 
1664-2295
Note: 
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).
Citation: 
Carmona-de la Torre, F. (Francisco de Asís); Mínguez-Olaondo, A.; López-Bravo, A.; et al. "Dysautonomia in COVID-19 patients: a narrative review on clinical course, diagnostic and therapeutic strategies". Frontiers in neurology. 13, 2022, 886609
Abstract
IntroductionOn 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. ObjectiveTo 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. ResultsAutonomic 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. ConclusionSymptoms 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.

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