Long-Haul Post-COVID-19 Symptoms Presenting as Postural Orthostatic Tachycardia Syndrome and Other Cardiovascular Dysautonomias

Bakgrund:

In the acute phase coronavirus disease-19 (COVID-19) causes multiple complications including pneumonia, respiratory distress syndrome, liver injury, cardiac injury, and prothrombotic coagulopathy. Long-term consequences of COVID-19 remain unknown. According to preliminary reports, chronic (“long-haul”) symptoms following COVID-19 infections indicate cardiovascular autonomic dysfunction, more specifically a presentation similar to that of postural orthostatic tachycardia syndrome (POTS).

POTS is the most prevalent chronic cardiovascular (CV) dysautonomia among young and middle-aged individuals, with a significant female predominance. It is characterized by chronic orthostatic intolerance, abnormal heart rate (HR) increase on standing, deconditioning and less specific symptoms including headache, cognitive dysfunction, fatigue, and dysmotility.

Målsättning: Aims of the project

1. To characterize patients with chronic post-COVID-19 symptoms and clinical suspicion of POTS and other forms of cardiovascular autonomic dysfunction. 2. To study the prevalence and characteristics of POTS and other CV dysautonomia forms in the above mentioned cohort.

3. To study the possible occurrence of concurrent abnormalities mimicking POTS and presenting with less specific symptoms of sinus tachycardia, chest pain, dyspnea, deconditioning or desaturation in the presence or absence of definitive POTS diagnosis. Arbetsplan:

Patients who will meet the study criteria i.e. with high pretest suspicion of POTS will be included and complete basic symptom assessment questionnaires. The participant will then undergo CV autonomic testing plus cardiac workup. Cardiac imaging will include echocardiography, exercise ECG, perfusion cardiac MRI and cardiac nuclear imaging, if symptoms suggestive of angina pectoris and negative cardiac workup will be present.

In the next step, patients will be evaluated by cardiopulmonary workup according to the “pulmonary pathway”, if symptoms suggestive of respiratory etiology are present. Finally, the patients will be investigated for the presence of traditional autoimmune and inflammatory plasma biomarkers.

Betydelse:COVID-19 pandemic has affected millions of people worldwide, and numbers are continuing to increase. Therefore, systematic characterization of long-haul post-COVID-19 patients presenting with symptoms of POTS and other CV dysautonomias is of utmost importance.