Postural Orthostatic Tachycardia Syndrome Associated with COVID-19: A Narrative Review
Abstract
:1. Introduction
1.1. Definition and Clinical Features of POTS
1.2. Current Clinical Spectrum
2. COVID-19-Related POTS
2.1. Definition
2.2. Presumed Mechanism for COVID-19-Related POTS
2.2.1. Renin–Angiotensin–Aldosterone System (RAAS) Dysregulation
2.2.2. Hyperadrenergic Reaction
2.2.3. Direct Viral Infection
2.2.4. Mechanism of Post-COVID-19 Tachycardia Syndrome
3. Diagnosis of COVID-19-Related POTS
Differential Diagnosis
4. Management
4.1. Patient Education
4.2. Exercise
4.3. Treatment for COVID-19-Related POTS Due to Hypovolemia
4.4. Treatment for COVID-19-Related POTS Due to Intravenous or Splanchnic Pooling
4.5. Treatments for COVID-19-Related POTS Due to Increased Norepinephrine in the Blood
4.6. Treatment for COVID-19-Related POTS Due to an Autoimmune Mechanism
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Common | Hypovolemia | Intravenous/Splanchnic Pooling | Blood Norepinephrine Level Increase | Autoimmunity | |
---|---|---|---|---|---|
Non-pharmacological treatment | Avoid lying down for a long time. Stand up gradually, especially after meals and urination. Avoid exposure to high temperature and humidity. Avoid eating a large amount at once. Physical counter-pressure maneuvering and contraction of gastrocnemius muscle and tensor muscle. Maintain good sleep hygiene. Exercises: aerobic exercise and thigh resistance training. | 10 g or more of sodium per day/water 3 L or more. Elevating head-end of the bed 10 cm for sleeping. Sleeping in seated position. | Compression stockings, clothes. Eating habits: consuming small amounts of food multiple times per day or conducting food elimination. | ||
Pharmacological treatment | Fludrocortisone Desmopressin Midodrine Withdrawal of drugs that interfere with liquid balance | Midodrine Droxidopa Octreotide | Propranolol Bisoprolol Metoprolol Atenolol Ivabradine Clonidine Methyldopa | Pyridostigmine |
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Park, J.-H.; Park, S.; Kim, N.-H.; Lee, Y.; Chang, Y.; Song, T.-J. Postural Orthostatic Tachycardia Syndrome Associated with COVID-19: A Narrative Review. Medicina 2024, 60, 1325. https://doi.org/10.3390/medicina60081325
Park J-H, Park S, Kim N-H, Lee Y, Chang Y, Song T-J. Postural Orthostatic Tachycardia Syndrome Associated with COVID-19: A Narrative Review. Medicina. 2024; 60(8):1325. https://doi.org/10.3390/medicina60081325
Chicago/Turabian StylePark, Jung-Hyun, Somin Park, Na-Hye Kim, Yoonjin Lee, Yoonkyung Chang, and Tae-Jin Song. 2024. "Postural Orthostatic Tachycardia Syndrome Associated with COVID-19: A Narrative Review" Medicina 60, no. 8: 1325. https://doi.org/10.3390/medicina60081325