RESUMEN
This Diagnostic Test Interpretation uses a patient case to illustrate tilt table testing, useful for evaluating patients with syncope of unknown cause or postural orthostatic tachycardia syndrome (POTS).
Asunto(s)
Síndrome Post Agudo de COVID-19 , Síndrome de Taquicardia Postural Ortostática , Pruebas de Mesa Inclinada , Humanos , Síncope/etiología , Femenino , Adulto , COVID-19/complicaciones , Síndrome Post Agudo de COVID-19/complicaciones , Síndrome de Taquicardia Postural Ortostática/diagnóstico , Síndrome de Taquicardia Postural Ortostática/etiologíaAsunto(s)
Síndrome Post Agudo de COVID-19 , Síndrome de Taquicardia Postural Ortostática , Humanos , Antiinfecciosos/uso terapéutico , Fármacos Cardiovasculares/uso terapéutico , Ensayos Clínicos como Asunto , COVID-19/complicaciones , COVID-19/terapia , Tratamiento Farmacológico de COVID-19 , Inmunoglobulinas Intravenosas/uso terapéutico , Ivabradina/uso terapéutico , Enfermedades del Sistema Nervioso/etiología , Enfermedades del Sistema Nervioso/terapia , Síndrome Post Agudo de COVID-19/etiología , Síndrome Post Agudo de COVID-19/terapia , Síndrome de Taquicardia Postural Ortostática/etiología , Síndrome de Taquicardia Postural Ortostática/terapiaAsunto(s)
Vacunas contra la COVID-19 , COVID-19 , Síndrome de Taquicardia Postural Ortostática , Neuropatía de Fibras Pequeñas , Humanos , COVID-19/prevención & control , Vacunas contra la COVID-19/efectos adversos , Neuropatía de Fibras Pequeñas/complicaciones , Síndrome de Taquicardia Postural Ortostática/etiologíaRESUMEN
BACKGROUND: There is an association between coronavirus disease 2019 (COVID-19) mRNA vaccination and the incidence or exacerbation of postural orthostatic tachycardia syndrome (POTS). OBJECTIVE: The purpose of this study was to characterize patients reporting new or exacerbated POTS after receiving the mRNA COVID-19 vaccine. METHODS: We prospectively collected data from sequential patients in a POTS clinic between July 2021 and June 2022 reporting new or exacerbated POTS symptoms after COVID-19 vaccination. Heart rate variability (HRV) and skin sympathetic nerve activity (SKNA) were compared against those of 24 healthy controls. RESULTS: Ten patients (6 women and 4 men; age 41.5 ± 7.9 years) met inclusion criteria. Four patients had standing norepinephrine levels > 600 pg/mL. All patients had conditions that could raise POTS risk, including previous COVID-19 infection (N = 4), hypermobile Ehlers-Danlos syndrome (N = 6), mast cell activation syndrome (N = 6), and autoimmune (N = 7), cardiac (N = 7), neurological (N = 6), or gastrointestinal conditions (N = 4). HRV analysis indicated a lower ambulatory root mean square of successive differences (46.19 ±24 ms; P = .042) vs control (72.49 ± 40.8 ms). SKNA showed a reduced mean amplitude (0.97 ± 0.052 µV; P = .011) vs control (1.2 ± 0.31 µV) and burst amplitude (1.67 ± 0.16 µV; P = .018) vs control (4. 3 ± 4.3 µV). After 417.2 ± 131.4 days of follow-up, all patients reported improvement with the usual POTS care, although 2 with COVID-19 reinfection and 1 with small fiber neuropathy did have relapses of POTS symptoms. CONCLUSION: All patients with postvaccination POTS had pre-existing conditions. There was no evidence of myocardial injuries or echocardiographic abnormalities. The decreased HRV suggests a sympathetic dominant state. Although all patients improved with guideline-directed care, there is a risk of relapse.