Patient-Centered Paradigm for Managing Autonomic Long COVID Symptoms During Sports and Exercise

Area of Science:

• Cardiology
• Neurology
• Infectious Diseases

Background:

• Post-COVID-19 dysautonomia is a growing concern, affecting patients' ability to engage in physical activity.
• Symptoms include postural orthostatic tachycardia and exertional tachycardia, leading to significant fatigue.

Purpose of the Study:

• To present a novel, patient-centered management strategy for exercise-related dysautonomia following COVID-19 infection.
• To explore effective treatment options when standard interventions are poorly tolerated.

Main Methods:

• A case report of a healthcare worker with post-COVID-19 dysautonomia.
• Utilized a novel medication regimen: basal-dose ivabradine combined with a low-dose metoprolol "sliding scale" for exertional symptoms.
• Standard diagnostic tests including stress tests and echocardiograms were performed.

Main Results:

• The novel medication regimen effectively managed symptoms of postural orthostatic tachycardia and exertional tachycardia.
• The patient achieved an acceptable level of symptom control for work and recreational activities.
• Initial diagnostic evaluations for dysautonomia were negative, highlighting the need for tailored treatment.

Conclusions:

• A personalized approach combining ivabradine and metoprolol can be a viable strategy for managing post-COVID-19 dysautonomia during exercise.
• This regimen offers a potential solution for patients intolerant to conventional therapies.
• Further research is warranted to validate this approach in a larger cohort.