Postural orthostatic tachycardia syndrome and other autonomic dysfunctions following COVID‐19: Incidence, characteristics, and associated factors

C. Tanking, C. Lakkananurak, C. Srisakvarakul, A. Jitpreeda, K. Threechod, D. Sukitpunyaroj
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Abstract

Long‐COVID syndrome has become a new health concern. Many major clinical centers have experienced more patients with symptoms suggestive of autonomic dysfunction, especially postural orthostatic tachycardia syndrome (POTS) following COVID‐19. However, there is a lack of information regarding the incidence and associated factors in Asian population.A retro‐prospective study was conducted to evaluate patients with symptoms suggestive of POTS or other autonomic dysfunctions. These symptoms last at least 3 months after PCR‐proven COVID‐19. Exclusion criteria were age under 18 years old, pregnancy, and pre‐COVID‐19 autonomic dysfunction symptoms. Patients with a symptom severity score greater than two were assessed with blood tests, 24‐h Holter, 24‐h ambulatory blood pressure, echocardiogram, and head‐up tilt table (HUTT).Seven hundred ninety‐three patients were interviewed at 146 ± 37 days after COVID‐19. The majority of patients were middle‐aged females (53%). Of those, 15 patients had the symptom severity score greater than 2. Out of those 15 patients, 12 had positive HUTT (1 demonstrating POTS, 10 neurocardiogenic syncope, and 1 orthostatic hypotension). Among those with positive HUTT patients, C‐reactive protein (CRP) was significantly higher (OR 1.01; p‐value 0.041). Fatigue and dyspnea on exertion were the two most complaint symptoms.This study shows the incidence of autonomic dysfunction and POTS is 1.5% (12/793) and 0.1% POTS (1/793), respectively, in a primary care setting (among general post‐COVID‐19 patients). The most common symptoms for these patients were fatigue and dyspnea.
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COVID-19 之后的体位性正位性心动过速综合征和其他自主神经功能障碍:发病率、特征和相关因素
长期 COVID 综合征已成为一个新的健康问题。许多大型临床中心发现,越来越多的患者出现了提示自主神经功能紊乱的症状,尤其是 COVID-19 之后的体位性正位性心动过速综合征(POTS)。我们开展了一项回顾性研究,对有 POTS 或其他自主神经功能障碍症状的患者进行评估。这些症状在 PCR 证实 COVID-19 后至少持续 3 个月。排除标准为年龄小于 18 岁、怀孕和 COVID-19 前的自主神经功能紊乱症状。对症状严重程度大于 2 分的患者进行了血液化验、24 小时 Holter、24 小时动态血压、超声心动图和抬头倾斜台(HUTT)评估。大多数患者为中年女性(53%)。其中,15 名患者的症状严重程度大于 2 分。在这 15 名患者中,12 人的 HUTT 呈阳性(1 人表现为 POTS,10 人表现为神经性心源性晕厥,1 人表现为正性低血压)。在 HUTT 呈阳性的患者中,C 反应蛋白 (CRP) 明显较高(OR 1.01;P 值 0.041)。这项研究显示,在初级医疗机构(COVID-19 后的普通患者)中,自律神经功能紊乱和 POTS 的发病率分别为 1.5%(12/793)和 0.1%(1/793)。这些患者最常见的症状是疲劳和呼吸困难。
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