Autonomic dysfunction and postural orthostatic tachycardia syndrome in post-acute COVID-19 syndrome, 2023, Artur Fedorowski

The post-acute sequelae of COVID-19 present major problems for many patients, their physicians and the health-care system. They are unrelated to the severity of the initial infection, are often highly symptomatic and can occur after vaccination. Many sequelae involve cardiovascular autonomic dysfunction, with postural orthostatic tachycardia syndrome in 30% of individuals. Prognosis is unknown, and treatment is still unsatisfactory.

https://www.nature.com/articles/s41569-023-00842-w

 

Thank you to these authors for highlighting orthostatic issues in long COVID.

We need the same focus on POTS etc., for ME.

I have POTS, and have tachycardia while upright, as well as while supine.

IME, cardiologists were very disdainful of "cfs", as of course were most other medical disciplines.



We need both cardiologists and GPs to recognize, and test for this common symptom for pwME.


There is clearly something to Orthostatic intolerance in ME, given peer reviewed study results on this, and other findings:

https://me-pedia.org/wiki/Orthostatic_intolerance

A note regarding protocol on testing - for in office supine versus standing, physicians will hopefully see the necessity of taking the recommended time for this test, 10 minutes.

An in office testing protocol was developed by the Bateman Horner Center:

https://batemanhornecenter.org/wp-content/uploads/2016/09/NASA-Lean-Test-Instructions-1.pdf

 

Not bad. Welcome to 3 years ago, though. Or 30. Whatever, this is 100x better than average. "Chronic fatigue", though. Ugh.

COVID-19 landscape1, calling for more diagnostic vigilance, greater availability of health-care resources and new therapeutic options. Interestingly, POTS and related conditions, such as mast cell disorders, chronic fatigue and general dysautonomia, are diagnosed more often in the 3 months after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but can also develop after COVID-19 vaccination. The medium-term to long-term prognosis is not well understood8, but one report suggests that many patients can spontaneously recover over the next 12 months9.​

Beliefs in medicine that dysautonomia cannot be caused by infections remain strong, sadly. Usually assumptions make an ass out of u and me, but in this case they destroyed millions of lives. Not smart. Very not smart.

 

The author asked me what other type of post-infectious syndromes I was referring to. I replied ME/CFS.

 

Thanks @Mij for contacting the author.

OI is so very difficult with its multiple symptoms and effects. It would at least be a step forward to have more wide spread medical knowledge about this troubling symptom for pwME.

 

Fedorowski has had lots of patients with ME over the years, and I've been hearing very good things about him as a clinician from them.

 

@mango

This was my impression too, so I was a little surprised when he asked me "What are "post-infectious syndromes"?".

 

Could it maybe be a language thing? Here in Sweden the diagnosis is often called 'postviral trötthet', literally 'post-viral tiredness'. (See for example the upcoming webinar with ME specialist Julin and Fedorowski.) I'm not sure if 'postinfektiösa syndrom' is a commonly used umbrella term in Sweden? I'm aware that prof Jonas Bergquist sometimes uses it, though.

'Postinfektiösa tillstånd' seem to be much more common, especially in connection with covid-19.

I don't know. Could be just a simple misunderstanding too, I guess.

 

@mango

Thanks for the explanation!