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

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.