Abbate Gerardina, De Iulio Beatrice, Thomas Georgia, Priday Anna, Biondi-Zoccai Giuseppe, Markley Roshanak, Abbate Antonio
Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA.
Pauley Heart Center, Virginia Commonwealth University, Richmond, VA.
J Cardiovasc Pharmacol. 2023 Jul 1;82(1):23-31. doi: 10.1097/FJC.0000000000001432.
Postural orthostatic tachycardia syndrome (POTS) is a clinical syndrome of inappropriate increase in heart rate on standing that has been recently also associated with Coronavirus Disease 2019 (COVID-19) as part of the postacute 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; and (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 the United States, Norway, Sweden, Israel, Ireland, United Kingdom, 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. Nonpharmacologic treatments (fluids, sodium intake, and compression stockings) were virtually always used, but largely ineffective. Subjects received different treatments, the most common being beta-adrenergic blockers (ie, propranolol), mineral corticosteroids (ie, 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, which can be easily diagnosed with a thorough clinical assessment and measuring changes in orthostatic heart rate and blood pressure. POTS after COVID-19 seems to be poorly responsive to nonpharmacological 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.
体位性直立性心动过速综合征（POTS）是一种站立时心率不适当增加的临床综合征，最近它也与2019冠状病毒病（COVID-19）相关，作为COVID-19急性后遗症（PASC）或长新冠的一部分。我们在此旨在系统回顾COVID-19后POTS的报告病例，并确定受试者的特征、所采用的诊断方法和治疗策略。我们根据以下标准检索文献：（1）根据标准定义诊断为POTS；（2）与可能或确诊的COVID-19及时关联；（3）对个体受试者的描述。我们确定了2020年3月至2022年9月期间符合标准的21份报告，包括68名受试者（51名女性和17名男性，比例为3:1），平均年龄为34±12岁，报告来自美国、挪威、瑞典、以色列、爱尔兰、英国、新加坡和日本。大多数病例有轻度COVID-19症状。最常见的POTS症状是心悸、胸痛、头晕和使人衰弱的疲劳。通过头高位倾斜试验或主动站立试验确诊。几乎总是使用非药物治疗（补液、钠摄入和弹力袜），但大多无效。受试者接受了不同的治疗，最常见的是β-肾上腺素能阻滞剂（即普萘洛尔）、盐皮质激素（即氟氢可的松）、米多君和伊伐布雷定。症状往往会随着时间改善，但大多数患者在数月内仍有症状。总之，COVID-19后的POTS是一种影响年轻人，尤其是年轻女性的临床病症，作为PASC-长新冠的一部分出现，常常使人衰弱，通过全面的临床评估以及测量直立性心率和血压变化可轻易诊断。COVID-19后的POTS似乎对非药物治疗反应不佳，但药物干预可改善症状。鉴于现有数据有限，迫切需要对其流行病学、病理生理学和治疗进行更多研究。
