tetano
Editor, Senior Moderator
J Cardiovasc Pharmacol
. 2023 Apr 22.
doi: 10.1097/FJC.0000000000001432. Online ahead of print.
JCEHP-21-0367Postural Orthostatic Tachycardia Syndrome After COVID-19: a Systematic Review of Therapeutic Interventions
Gerardina Abbate[SUP] 1 [/SUP], Beatrice De Iulio[SUP] 1 [/SUP], Georgia Thomas[SUP] 2 [/SUP], Anna Priday[SUP] 1 [/SUP], Giuseppe Biondi-Zoccai[SUP] 3 4 [/SUP], Roshanak Markley[SUP] 2 [/SUP], Antonio Abbate[SUP] 1 [/SUP]
Affiliations
Abstract
Postural orthostatic tachycardia syndrome (POTS) is a clinical syndrome of inappropriate increase in heart rate upon standing that has been recently also associated with Coronavirus Disease 2019 (COVID-19) as part of the post-acute sequelae of COVID-19 (PASC) or long-COVID. We herein aimed to systematically review reported cases of POTS after COVID-19 and determine the characteristics of the subjects, the diagnostic approach used, and the treatment strategies. We searched the literature according to the following criteria: (1) diagnosis of POTS according to standard definition; (2) timely association with a probable or definite diagnosis of COVID-19; (3) a description of the individual subject(s). We identified 21 reports meeting criteria between March 2020 and September 2022, including 68 subjects (51 females and 17 males, 3:1 ratio) with a mean age of 34±12 years, with reports deriving from USA, Norway, Sweden, Israel, Ireland, UK, Singapore and Japan. Most cases had mild COVID-19 symptoms. The most common POTS symptoms were palpitations, chest pain, lightheadedness, and debilitating fatigue. The diagnosis was established by means of head-up tilt table or active stand test. Non-pharmacologic treatments (fluids, sodium intake, and compression stockings) were virtually always utilized, but largely ineffective. Subjects received different treatments, the most common being beta-adrenergic blockers (i.e. propranolol), mineral-corticosteroids (i.e. fludrocortisone), midodrine, and ivabradine. Symptoms tended to improve over time, but most patients remained symptomatic for several months. In conclusion, POTS after COVID-19 is a clinical condition affecting young individuals, and disproportionately young women, occurring as part of PASC - long-COVID, often debilitating, that can be easily diagnosed with a thorough clinical assessment and measuring changes in orthostatic heart rate and blood pressure. POTS after COVID-19 appears to be poorly responsive to non-pharmacological treatments but with symptoms improving with pharmacological interventions. Given the limited data available, additional research is urgently needed with respect to its epidemiology, pathophysiology, and treatments.
. 2023 Apr 22.
doi: 10.1097/FJC.0000000000001432. Online ahead of print.
JCEHP-21-0367Postural Orthostatic Tachycardia Syndrome After COVID-19: a Systematic Review of Therapeutic Interventions
Gerardina Abbate[SUP] 1 [/SUP], Beatrice De Iulio[SUP] 1 [/SUP], Georgia Thomas[SUP] 2 [/SUP], Anna Priday[SUP] 1 [/SUP], Giuseppe Biondi-Zoccai[SUP] 3 4 [/SUP], Roshanak Markley[SUP] 2 [/SUP], Antonio Abbate[SUP] 1 [/SUP]
Affiliations
- PMID: 37094584
- DOI: 10.1097/FJC.0000000000001432
Abstract
Postural orthostatic tachycardia syndrome (POTS) is a clinical syndrome of inappropriate increase in heart rate upon standing that has been recently also associated with Coronavirus Disease 2019 (COVID-19) as part of the post-acute sequelae of COVID-19 (PASC) or long-COVID. We herein aimed to systematically review reported cases of POTS after COVID-19 and determine the characteristics of the subjects, the diagnostic approach used, and the treatment strategies. We searched the literature according to the following criteria: (1) diagnosis of POTS according to standard definition; (2) timely association with a probable or definite diagnosis of COVID-19; (3) a description of the individual subject(s). We identified 21 reports meeting criteria between March 2020 and September 2022, including 68 subjects (51 females and 17 males, 3:1 ratio) with a mean age of 34±12 years, with reports deriving from USA, Norway, Sweden, Israel, Ireland, UK, Singapore and Japan. Most cases had mild COVID-19 symptoms. The most common POTS symptoms were palpitations, chest pain, lightheadedness, and debilitating fatigue. The diagnosis was established by means of head-up tilt table or active stand test. Non-pharmacologic treatments (fluids, sodium intake, and compression stockings) were virtually always utilized, but largely ineffective. Subjects received different treatments, the most common being beta-adrenergic blockers (i.e. propranolol), mineral-corticosteroids (i.e. fludrocortisone), midodrine, and ivabradine. Symptoms tended to improve over time, but most patients remained symptomatic for several months. In conclusion, POTS after COVID-19 is a clinical condition affecting young individuals, and disproportionately young women, occurring as part of PASC - long-COVID, often debilitating, that can be easily diagnosed with a thorough clinical assessment and measuring changes in orthostatic heart rate and blood pressure. POTS after COVID-19 appears to be poorly responsive to non-pharmacological treatments but with symptoms improving with pharmacological interventions. Given the limited data available, additional research is urgently needed with respect to its epidemiology, pathophysiology, and treatments.