Related Experiment Video
Updated: Aug 17, 2025
Tachycardia-Induced Cardiomyopathy As a Chronic Heart Failure Model in Swine
Published on: February 17, 2018
Objective Hemodynamic Cardiovascular Autonomic Abnormalities in Post-Acute Sequelae of COVID-19
Rashmin Hira1, Jacquie R Baker1, Tanya Siddiqui1
1Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Insights
Post-acute sequelae of COVID-19 (PASC) frequently involve cardiovascular autonomic abnormalities (CAA), particularly initial orthostatic hypotension (IOH). Active stand testing is crucial for diagnosis, as these conditions affect both hospitalized and non-hospitalized individuals.
Area of Science:
- Cardiology
- Neurology
- Infectious Diseases
Background:
- Post-acute sequelae of COVID-19 (PASC) present with persistent symptoms.
- Cardiovascular autonomic abnormalities (CAA) are increasingly recognized in PASC patients.
- Prevalence and sex differences in CAA among PASC patients require further investigation.
Purpose of the Study:
- Determine the prevalence of objective hemodynamic CAA in PASC.
- Explore potential sex-based differences in CAA.
- Compare CAA prevalence in hospitalized versus non-hospitalized PASC patients.
Main Methods:
- Seventy patients with PASC underwent standard autonomic function tests.
- An active stand test was utilized to assess hemodynamic responses.
- Clinical autonomic abnormalities were evaluated, including postural orthostatic tachycardia syndrome (POTS) and initial orthostatic hypotension (IOH).
Main Results:
- 73% of PASC patients exhibited at least one CAA.
- Initial orthostatic hypotension (IOH40) was the most common abnormality (61%), equally prevalent in males and females.
- Postural orthostatic tachycardia syndrome (POTS_HR) was more frequent in females (P=0.037).
- CAA prevalence was similar in hospitalized (67%) and non-hospitalized (74%) patients.
Conclusions:
- PASC patients frequently present with CAA, primarily IOH40, detectable via active stand testing.
- Female patients show a higher incidence of POTS_HR, while IOH40 affects both sexes equally.
- Even mild, non-hospitalized COVID-19 infections can lead to long-term CAA.
Background:
Many COVID-19 patients are left with symptoms several months after resolution of the acute illness; this syndrome is known as post-acute sequalae of COVID-19 (PASC). We aimed to determine the prevalence of objective hemodynamic cardiovascular autonomic abnormalities (CAA), explore sex differences, and assess the prevalence of CAA among hospitalized vs nonhospitalized patients with PASC.
Methods:
Patients with PASC (n = 70; female [F] = 56; 42 years of age; 95% confidence interval [CI], 40-48) completed standard autonomic tests, including an active stand test 399 days (338, 455) after their COVID-19 infection. Clinical autonomic abnormalities were evaluated.
Results:
Most patients with PASC met the criteria for at least 1 CAA (51; 73%; F = 43). The postural orthostatic tachycardia syndrome hemodynamic (POTSHR) criterion of a heart rate increase of > 30 beats per minute within 5 to 10 minutes of standing was seen in 21 patients (30%; F = 20; P = 0.037 [by sex]). The initial orthostatic hypotension hemodynamic (IOH40) criterion of a transient systolic blood pressure change of > 40 mm Hg in the first 15 seconds of standing was seen in 43 (61%) patients and equally among female and male patients (63% vs 57%; P = 0.7). Only 9 (13%) patients were hospitalized; hospitalized vs nonhospitalized patients had similar frequencies of abnormalities (67% vs 74%; P = 0.7).
Conclusions:
Patients with PASC have evidence of CAA, most commonly IOH40, which will be missed unless an active stand test is used. Female patients have increased frequency of POTSHR, but IOH40 is equally prevalent between sexes. Finally, even nonhospitalized "mild" infections can result in long-term CAAs.
More Related Videos
Related Concept Videos
01:29Heart Failure II: Pathophysiology
01:18Disorders of the Autonomic Nervous System
Raynaud's disease, also known as Raynaud's...
01:26Heart Failure III: Clinical Manifestations
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Cardiomyopathy II: Dilated Cardiomyopathy