COVID-19 is a global pandemic that has had a devastating effect on the health and economy of much of human civilization. While the acute impacts of COVID-19 were the initial focus of concern, it is becoming clear that in the wake of COVID-19, many patients are developing chronic symptoms that have been called Long-COVID. Some of the symptoms and signs include those of postural tachycardia syndrome (POTS). Understanding and managing long-COVID POTS will require a significant infusion of health care resources and a significant additional research investment. In this document from the American Autonomic Society, we outline the scope of the problem, and the resources and research needed to properly address the impact of Long-COVID POTS.

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COVID-19 is a global pandemic that is wreaking havoc with the health and economy of much of human civilization. In this document from the American Autonomic Society, we identify the potential risks of exposure to patients, physicians, and allied healthcare staff. We provide guidance for conducting autonomic function testing safely in this environment. Statement of the problem The novel coronavirus (SARS-CoV-2) emerged in Wuhan, China, in late 2019. It quickly became a pandemic, significantly impacting the health and economy of the USA, many European countries, and the rest of the world [1, 2]. There are hundreds of thousands of deaths related to COVID-19 (the disease caused by SARS-CoV-2) worldwide, with an estimated mortality rate ranging from 1% to 5% [2]. This healthcare crisis has imposed an unprecedented strain on society in general, and in particular it has challenged the ability of healthcare organizations to provide adequate care, including to patients without COVID-19. The purpose of this statement is to provide guidance to physicians, staff, and healthcare systems on the performance of autonomic function testing in these unusual times. There are no randomized trial data addressing these issues, so the thoughts here reflect the opinions of leaders in autonomic disorders and testing with insights from experts in infection control.

Visual evidence of wall thickening by poststress ECG-gated SPECT sestamibi imaging in the territory of a stress-induced perfusion defect correlates highly with stress defect reversibility on rest imaging and may obviate the need to perform rest imaging, thereby potentially reducing the time and cost involved in myocardial perfusion imaging. The absence of visually apparent wall thickening, however, underestimates the prevalence of stress defect reversibility on rest imaging; in such instances, rest imaging must be performed to differentiate ischemia from infarction in the territory of a stress perfusion defect.