Gómez-Moyano Elisabeth, Rodríguez-Capitán Jorge, Gaitán Román Daniel, Reyes Bueno José Antonio, Villalobos Sánchez Aurora, Espíldora Hernández Francisco, González Angulo Gracia Eugenia, Molina Mora María José, Thurnhofer-Hemsi Karl, Molina-Ramos Ana Isabel, Romero-Cuevas Miguel, Jiménez-Navarro Manuel, Pavón-Morón Francisco Javier
Department of Dermatology, Hospital Regional Universitario de Málaga, Málaga, Spain.
Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), IBIMA-Plataforma BIONAND, Universidad de Málaga, Málaga, Spain.
Front Neurol. 2023 Aug 16;14:1221518. doi: 10.3389/fneur.2023.1221518. eCollection 2023.
The COVID-19 pandemic has caused a challenge for our society due to the post-acute sequelae of the disease. Persistent symptoms and long-term multiorgan complications, known as post-acute COVID-19 syndrome, can occur beyond 4 weeks from the onset of the COVID-19 infection. Postural orthostatic tachycardia syndrome (POTS) is considered a variety of dysautonomia, which is characterized by chronic symptoms that occur with standing and a sustained increase in heart rate, without orthostatic hypotension. POTS can lead to debilitating symptoms, significant disability, and impaired quality of life. In this narrative review, the etiopathogenic basis, epidemiology, clinical manifestations, diagnosis, treatment, prognosis, and socioeconomic impact of POTS, as well as other related dysautonomic disorders, after COVID-19 infection and SARS-CoV-2 postvaccination, were discussed. After a search conducted in March 2023, a total of 89 relevant articles were selected from the PubMed, Google Scholar, and Web of Science databases. The review highlights the importance of recognizing and managing POTS after COVID-19 infection and vaccination, and the approach to autonomic disorders should be known by all specialists in different medical areas. The diagnosis of POTS requires a comprehensive clinical assessment, including a detailed medical history, physical examination, orthostatic vital signs, and autonomic function tests. The treatment of POTS after COVID-19 infection or vaccination is mainly focused on lifestyle modifications, such as increased fluid and salt intake, exercise, and graduated compression stockings. Pharmacotherapy, such as beta-blockers, fludrocortisone, midodrine, and ivabradine, may also be used in selected cases. Further research is needed to understand the underlying mechanisms, risk factors, and optimal treatment strategies for this complication.
由于新冠疾病的急性后遗症，新冠疫情给我们的社会带来了挑战。持续症状和长期多器官并发症，即所谓的新冠后急性综合征，可在新冠感染发病4周后出现。体位性直立性心动过速综合征（POTS）被认为是一种自主神经功能障碍，其特征是站立时出现慢性症状且心率持续增加，无直立性低血压。POTS可导致使人衰弱的症状、严重残疾和生活质量受损。在这篇叙述性综述中，讨论了新冠感染和接种新冠病毒疫苗后POTS以及其他相关自主神经功能障碍的病因基础、流行病学、临床表现、诊断、治疗、预后和社会经济影响。在2023年3月进行检索后，从PubMed、谷歌学术和科学网数据库中总共筛选出89篇相关文章。该综述强调了认识和管理新冠感染和接种疫苗后POTS的重要性，不同医学领域的所有专家都应了解自主神经障碍的处理方法。POTS的诊断需要全面的临床评估，包括详细的病史、体格检查、直立位生命体征和自主神经功能测试。新冠感染或接种疫苗后POTS的治疗主要集中在生活方式的改变，如增加液体和盐分摄入、锻炼以及使用分级压力袜。在某些特定情况下，也可能使用药物治疗，如β受体阻滞剂、氟氢可的松、米多君和伊伐布雷定。需要进一步研究以了解这种并发症的潜在机制、危险因素和最佳治疗策略。
