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Dysautonomia in COVID-19 Patients: A Narrative Review on Clinical Course, Diagnostic and Therapeutic Strategies
oleh: Francisco Carmona-Torre, Francisco Carmona-Torre, Francisco Carmona-Torre, Ane Mínguez-Olaondo, Ane Mínguez-Olaondo, Ane Mínguez-Olaondo, Ane Mínguez-Olaondo, Ane Mínguez-Olaondo, Alba López-Bravo, Alba López-Bravo, Beatriz Tijero, Beatriz Tijero, Beatriz Tijero, Vesselina Grozeva, Michaela Walcker, Harkaitz Azkune-Galparsoro, Harkaitz Azkune-Galparsoro, Harkaitz Azkune-Galparsoro, Adolfo López de Munain, Adolfo López de Munain, Adolfo López de Munain, Adolfo López de Munain, Adolfo López de Munain, Adolfo López de Munain, Ana Belen Alcaide, Ana Belen Alcaide, Jorge Quiroga, Jorge Quiroga, Jorge Quiroga, Jorge Quiroga, Jose Luis del Pozo, Jose Luis del Pozo, Jose Luis del Pozo, Juan Carlos Gómez-Esteban, Juan Carlos Gómez-Esteban, Juan Carlos Gómez-Esteban, Juan Carlos Gómez-Esteban, Juan Carlos Gómez-Esteban, Juan Carlos Gómez-Esteban
Format: | Article |
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Diterbitkan: | Frontiers Media S.A. 2022-05-01 |
Deskripsi
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.