BREAKING! COVID-19 News: European Meta Study Validates That SARS-CoV-2 Infections Can Cause Cardiovascular Autonomic Dysfunction In Many!

COVID-19 News: A new study by European researchers have found that SARS-CoV-2 infections can lead to cardiovascular autonomic dysfunction in many.


 
Unlike direct virus effects on the heart which is also another occurrence of SARS-CoV-2 infections, cardiovascular autonomic neuropathy (CAN) encompasses virus damage to the autonomic nerve fibers that innervate the heart and blood vessels, resulting in abnormalities in heart rate control and vascular dynamics. It is a neurological manifestation that affects the heart.
 
Alterations in autonomic function ca result in inter-related cardiac conditions, including hypertension, myocardial ischemia, heart failure, cardiac arrhythmias including POTS (Postural orthostatic tachycardia syndrome) and sudden cardiac death.
 
The study team comprised of researchers from Centro Hospitalar e Universitário de Coimbra-Portugal, University of Lisbon-Portugal, University Hospital Centre Zagreb-Croatia, Medical University of Innsbruck-Austria, Landesklinikum Mistlb ach-Gänserndorf-Austria, Technische Universität München-Germany and University Hospital Tulln-Austria.
 
Although cardiovascular autonomic dysfunction has been reported in many Post COVID individuals, the available evidence is scattered and many have still not yet accepted the fact that many dying of sudden heart failures in the post-COVID era could be due to cardiovascular autonomic dysfunction.
 
The study team sought to understand the acute and mid-term effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on cardiovascular autonomic function.
 
The researchers performed a systematic PubMed, Embase, Web of Science, medRxiv, and bioRxiv search for cases of cardiovascular autonomic dysfunction during an acute SARS-CoV-2 infection, post-COVID-19 condition. The clinical-demographic characteristics of individuals in the acute versus post-COVID-19 phase were compared.
The study team screened 6470 titles and abstracts. Fifty-four full-length articles were included in the data synthesis.
 
A total of one-hundred thirty-four cases were identified: 81 during the acute SARS-CoV-2 infection (24 thereof diagnosed by history), 53 in the post-COVID-19 phase.
 
The study findings showed that most post-COVID cases were younger than those with cardiovascular autonomic disturbances in the acute SARS-CoV-2 phase (42 vs. 51-year-old, p=0.002) and were more frequently women (68% vs. 49%, p=0.034). Reflex syncope was the most common cardiovascular autonomic disorder in the acute phase (p=0.008), postural orthostatic tachycardia syndrome (POTS) the most frequent diagnosis in people with post-COVID-19 orthostatic complaints (p<0.001). Full recovery was more frequent in people with acute versus post-COVID-19 onset of cardiovascular autonomic disturbances (43% vs. 15%, p=0.002).
 
The study findings show strong evidence from the scientific literature about different types of cardiovascular autonomic dysfunction developing during and after COVID-19. However more studies are warranted about the prevalence of autonomic disorders associated with a SARS-CoV-2 infection are needed to quantify its impact on human health especially in the Post COVID era.
 
The study findings were publish ed in the peer reviewed European Journal of Neurology. https://onlinelibrary.wiley.com/doi/10.1111/ene.15714
 
Thailand Medical News has covered about COVID-19 induced Dysautonomia in our past COVID-19 News coverages.
 
https://www.thailandmedical.news/news/coronavirus-news-mayo-clinic-study-shows-that-covid-19-can-cause-dysautonomia
 
However, to date, this is the first detailed systematic review that provides information on cardiovascular autonomic involvement throughout the continuum of SARS-CoV-2 infection, from the acute phase to long-term complications.
 
The study team identified two patterns of cardiovascular autonomic involvement associated with COVID-19. The first occurred during acute SARS-CoV-2 infections, preferentially in middle-aged individuals with cardiovascular and metabolic comorbidities.
 
The study team did not find a gender prevalence in this group, which presented either with orthostatic intolerance, syncope, or sometimes a combination of both. 
 
Interestingly, the most common diagnosis in this phase was reflex syncope.
 
However, the second pattern of cardiovascular autonomic disturbances occurred commonly in younger women, more than four weeks after the acute COVID-19 infection and consisted more homogeneously of orthostatic intolerance. Most of these cases were diagnosed with POTS (Postural orthostatic tachycardia syndrome).
 
Besides the pattern of cardiovascular autonomic dysfunction, the clinical outcome also differed significantly between the two patient groups. 
 
Although reflex syncope during the acute COVID-19 infection often resulted in   complete recovery, those who developed cardiovascular autonomic dysfunction in the post-COVID-19 stage, most frequently experienced partial or no recovery, even after mild acute SARS-CoV-2 infection.
 
The analyzed evidence indicates that cardiovascular autonomic dysfunction may occur in both the acute and post-COVID-19 stages, but the above-mentioned differences in the clinical   presentation, latency to onset, and outcome at follow-up   suggest that the   pathophysiological basis may differ between the acute and post-COVID-19 phase. 
 
The study findings also suggest that the acute SARS-CoV-2 infection triggered   a   functional, but not permanent, structural damage of the cardiovascular autonomic nervous system and that, altogether, the severity of the acute SARS-CoV-2 infection rather than the autonomic involvement was a major determinant of the global clinical outcome at follow-up.
 
To date, at least one-third of patients worldwide remain symptomatic or newly develop multiple symptoms even several weeks after an acute SARS-CoV-2 infection. Many post-COVID-1 9 symptoms are non-specific (e.g. dizziness, brain fog, headache, palpitations), but usually occur during standing or exertion and have been therefore attributed to an underlying cardiovascular autonomic dysfunction.
https://pubmed.ncbi.nlm.nih.gov/35393771/
 
The high frequency of newly diagnosed POTS cases in the post-COVID-19 phase is particularly interesting and may point towards an immune-mediated mechanism of disease through an alteration of the vagal anti-inflammatory effect, hypoxia-triggered baroreflex unloading and/or altered chemoreflex sensitivities, often found in individuals with POTS.
https://pubmed.ncbi.nlm.nih.gov/34144933/
 
Although POTS, per se, remains a not fully understood clinical syndrome likely encompassing multiple endophenotypes and underlying etiologies, cases of POTS due to aberrant post-viral immune activation have been previously described, especially in young women.
https://pubmed.ncbi.nlm.nih.gov/16018168/
 
The positive medical history of some of the cases included in the present analysis for autoimmune (celiac disease, eczema, status post-Lyme, Hashimoto’s disease) or allergic disorders (mast cell activation syndrome, asthma, rhinitis, conjunctivitis), especially in the group of individuals who developed cardiovascular autonomic dysfunction in the post-COVID-19 phase, might point towards an immune-mediated mechanism of action.
 
However, the causal association between a passed SARS-CoV-2 infection and subsequent development of cardiovascular autonomic dysfunction remains overall elusive because there is no definitive marker for such a diagnosis.
 
The study team concluded that in COVID-19-related cardiovascular autonomic dysfunction, the study findings showed two incidence peaks in the acute phase: the first, during the first week, characterized mainly by reflex syncope, and the second, starting with the second or third week after the infection and evolving into stable conditions, such as POTS.
 
A diagnosis of POTS, in particular, requires symptoms to evolve over at least three months, a follow-up time that was not always reached by the included reports. A longer follow-up time than the one reported in the available literature would be also required to accurately assess the efficacy of established therapeutic regimens and clinical outcome at follow-up.
 
The study team said that in summary, different patterns of cardiovascular autonomic dysfunction may occur in both the acute and the post-COVID-19 phases and may significantly impact on overall clinical outcome. A high degree of vigilance is recommended, and the diagnosis should be ideally laboratory-based   to   exclude   mimicries and   promptly   establish appropriate   therapeutic    measures. While there are still face large gaps in knowledge, action should be undertaken to increase the alertness for cardiovascular autonomic complications following a COVID-19 infection and gain insights into their real prevalence in people with post-COVID-19 orthostatic complaints.
 
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