Reiner Martin F, Schmidt Dörthe, Frischknecht Lukas, Ruschitzka Frank, Duru Firat, Saguner Ardan M
Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
Department of Immunology, University Hospital Zurich, Zurich, Switzerland.
Eur Heart J Case Rep. 2023 Aug 19;7(8):ytad390. doi: 10.1093/ehjcr/ytad390. eCollection 2023 Aug.
Postural tachycardia syndrome (POTS) is characterized by orthostatic intolerance and heart rate increase in an upright position without orthostatic hypotension. It has been described after coronavirus disease-19 (COVID-19) as well as after COVID-19 vaccination.
A 54-year-old female patient presented with a 9-months history of severe orthostatic intolerance since COVID-19 vaccination with messenger RNA (mRNA)-1273 (Spikevax, Moderna). Except for diet-controlled coeliac disease, the patient was healthy, had no allergies, and did not take regular medication. Tilt table testing revealed a significant heart rate increase to 168 bpm without orthostatic hypotension accompanied by light-headedness, nausea, and syncope, findings consistent with POTS. Potential underlying causes including anaemia, thyroid dysfunction, adrenal insufficiency, pheochromocytoma, (auto)-immune disease, chronic inflammation as well as neurological causes were ruled out. Echocardiography and cardiac stress magnetic resonance imaging (MRI) did not detect structural or functional heart disease or myocardial ischaemia. Forty-eight-hour-electrocardiogram (ECG) showed no tachycardias other than sinus tachycardia. Finally, genomic analysis did not detect an inherited arrhythmia syndrome. Serologic analysis revealed adequate immune response to mRNA-1273 vaccination without signs of previous severe acute respiratory syndrome-coronavirus-2 infection. While ivabradine was not tolerated and metoprolol extended release only slightly improved symptoms, physical exercise reduced orthostatic intolerance moderately. At a 5-months follow-up, the patient remained dependant on assistance for activities of daily living.
The temporal association of POTS with the COVID-19 vaccination in a previously healthy patient and the lack of evidence of an alternative aetiology suggests COVID-19 vaccination is the potential cause of POTS in this patient. To our knowledge, this is the first case reporting severe, long-term, and treatment-refractory POTS following COVID-19 vaccination with mRNA1273.
体位性心动过速综合征（POTS）的特征是体位不耐受以及在直立位时心率增加而无体位性低血压。在冠状病毒病19（COVID-19）感染后以及COVID-19疫苗接种后均有相关报道。
一名54岁女性患者自接种信使核糖核酸（mRNA）-1273（斯皮克瓦克斯，莫德纳公司）COVID-19疫苗后出现了9个月的严重体位不耐受病史。除饮食控制的乳糜泻外，该患者身体健康，无过敏史，未规律服药。倾斜试验显示心率显著增加至168次/分钟，无体位性低血压，伴有头晕、恶心和晕厥，这些表现符合POTS。排除了包括贫血、甲状腺功能障碍、肾上腺功能不全、嗜铬细胞瘤、（自身）免疫性疾病、慢性炎症以及神经学病因等潜在病因。超声心动图和心脏应激磁共振成像（MRI）未检测到结构性或功能性心脏病或心肌缺血。48小时心电图（ECG）显示除窦性心动过速外无其他心动过速。最后，基因分析未检测到遗传性心律失常综合征。血清学分析显示对mRNA-1273疫苗有充分的免疫反应，无既往严重急性呼吸综合征冠状病毒2感染的迹象。虽然伊伐布雷定不耐受，美托洛尔缓释片仅轻微改善症状，但体育锻炼适度减轻了体位不耐受。在5个月的随访中，患者日常生活活动仍需依赖他人协助。
在一名既往健康的患者中，POTS与COVID-19疫苗接种存在时间关联，且缺乏其他病因的证据，提示COVID-19疫苗接种是该患者POTS的潜在病因。据我们所知，这是首例报告接种mRNA1273 COVID-19疫苗后出现严重、长期且治疗难治性POTS的病例。
