Postural orthostatic tachycardia syndrome as a sequela of COVID-19.
Postural orthostatic tachycardia syndrome as a sequela of COVID-19.
复制标题
DOI：
10.1016/j.hrthm.2022.07.014
复制
发表时间：
2022-11
期刊：
影响因子：
5.5
通讯作者：
Taub, Pam R.
中科院分区：
文献类型：
--
作者：
Ormiston, Cameron K.;Swiatkiewicz, Iwona;Taub, Pam R.
关键词：
体位性站立性心动过速综合征（POTS）是一种复杂的多系统疾病，以站立性不耐受和心动过速为特征，可能由病毒感染引发。最近的报告表明，在感染严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）后的6-8个月内，2%-14%的冠状病毒病（COVID-19）幸存者会出现POTS， 9%-61%的人会出现类似POTS的症状，如心动过速、站立性不耐受、疲劳和认知障碍。covid -19后POTS的病理生理机制尚不清楚。目前的假设包括与SARS-CoV-2感染相关的自身免疫、自主神经功能障碍、SARS-CoV-2对自主神经系统的直接毒性损伤以及SARS-CoV-2入侵中枢神经系统。从业人员应积极评估急性后COVID-19综合征患者的POTS。鉴于covid -19后POTS的症状主要是慢性体位性心动过速，应考虑改变生活方式，同时使用降心率药物和其他药物治疗。例如，伊伐布雷定或β受体阻滞剂与压缩袜和增加盐和液体摄入量相结合已显示出潜力。治疗团队应该是多学科的，包括不同专业的医生、护士、心理学家和物理治疗师。此外，鉴于自COVID-19大流行开始以来对自主专科医生和诊所的需求不断增加，迫切需要更多资源来充分照顾这一患者群体。鉴于我们对covid -19后POTS的了解有限，有必要对其自然史、病理生理机制和理想治疗等主题进行进一步研究。本文综述了目前关于COVID-19与POTS之间关联的文献、可能的机制、患者评估、治疗方法以及未来提高我们对COVID-19后POTS理解的方向。
Postural orthostatic tachycardia syndrome (POTS) is a complex multisystem disorder characterized by orthostatic intolerance and tachycardia and may be triggered by viral infection. Recent reports indicate that 2%–14% of coronavirus disease 2019 (COVID-19) survivors develop POTS and 9%–61% experience POTS-like symptoms, such as tachycardia, orthostatic intolerance, fatigue, and cognitive impairment within 6–8 months of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Pathophysiological mechanisms of post–COVID-19 POTS are not well understood. Current hypotheses include autoimmunity related to SARS-CoV-2 infection, autonomic dysfunction, direct toxic injury by SARS-CoV-2 to the autonomic nervous system, and invasion of the central nervous system by SARS-CoV-2. Practitioners should actively assess POTS in patients with post–acute COVID-19 syndrome symptoms. Given that the symptoms of post–COVID-19 POTS are predominantly chronic orthostatic tachycardia, lifestyle modifications in combination with the use of heart rate–lowering medications along with other pharmacotherapies should be considered. For example, ivabradine or β-blockers in combination with compression stockings and increasing salt and fluid intake has shown potential. Treatment teams should be multidisciplinary, including physicians of various specialties, nurses, psychologists, and physiotherapists. Additionally, more resources to adequately care for this patient population are urgently needed given the increased demand for autonomic specialists and clinics since the start of the COVID-19 pandemic. Considering our limited understanding of post–COVID-19 POTS, further research on topics such as its natural history, pathophysiological mechanisms, and ideal treatment is warranted. This review evaluates the current literature available on the associations between COVID-19 and POTS, possible mechanisms, patient assessment, treatments, and future directions to improving our understanding of post–COVID-19 POTS.
登录
查看更多内容
影响因子：
4.6
作者：
Aranyó J;Bazan V;Lladós G;Dominguez MJ;Bisbal F;Massanella M;Sarrias A;Adeliño R;Riverola A;Paredes R;Clotet B;Bayés-Genís A;Mateu L;Villuendas R
通讯作者：
Villuendas R
影响因子：
9.6
作者：
GAFFNEY, FA;LANE, LB;BLOMQVIST, CG
通讯作者：
BLOMQVIST, CG
影响因子：
4.7
作者：
Al-Kuraishy HM;Al-Gareeb AI;Qusti S;Alshammari EM;Gyebi GA;Batiha GE
通讯作者：
Batiha GE
影响因子：
4
作者：
Anderson, Jake W.;Lambert, Elisabeth A.;Lambert, Gavin W.
通讯作者：
Lambert, Gavin W.
影响因子：
8.3
作者：
Fu, Qi;VanGundy, Tiffany B.;Levine, Benjamin D.
通讯作者：
Levine, Benjamin D.