Autonomic dysfunction in SARS-COV-2 infection acute and long-term implications COVID-19 editor’s page series

Abstract

The autonomic nervous system (ANS) is a complex network of nerves originating in the brain, brain stem, spinal cord, heart and extracardiac organs that regulates neural and physiological responses to internal and external environments and conditions. A common observation among patients with the 2019 Coronavirus (CoV) (SARS-severe acute respiratory syndrome CoV-2) (SARS-CoV-2) or COVID-19 [ CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019)] in the acute and chronic phases of the disease is tachycardia, labile blood pressure, muscular fatigue and shortness of breath. Because abnormalities in the ANS can contribute to each of these symptoms, herein a review of autonomic dysfunction in SARS-COV-2 infection is provided to guide diagnostic testing, patient care and research initiatives. Graphic abstract The autonomic nervous system is a complex network of nerves originating in the brain, brain stem, spinal cord, heart and extracardiac organs that regulates neural and physiological responses to internal and external environments and conditions. A common collection of signs and symptoms among patients with the 2019 Coronavirus (CoV) (SARS-severe acute respiratory syndrome CoV-2) (SARS-CoV-2) or COVID-19 [ CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019)] is tachycardia, labile blood pressure, muscular fatigue and shortness of breath. Abnormalities in the autonomic nervous system (ANS) can contribute to each of these identifiers, potentially offering a unifying pathobiology for acute, subacute and the long-term sequelae of SARS-CoV-2 infection (PASC) and a target for intervention.

Post-COVID-19 Syndrome: Involvement and Interactions between Respiratory, Cardiovascular and Nervous Systems

“…Interrupted sleep and irregular sleep patterns are frequent in COVID-19 patients [106]; either can lead to impaired autonomic tone and endothelial vasomotor dysfunction [107] with related symptoms. Moreover, depression affects the quality of life, habits and, consequently, the health status in its complexity.…”

Orthostatic Intolerance in Adults Reporting Long COVID Symptoms Was Not Associated With Postural Orthostatic Tachycardia Syndrome

“…The neurological and cardiovascular overlap in some long COVID symptoms, and in particular the reported occurrence of orthostatic intolerance (OI) (Dani et al, 2021;Paterson et al, 2021;Shah et al, 2021), have raised the hypothesis as to whether some long COVID patients could have measurable autonomic nervous system impairments (Del Rio et al, 2020;Goldstein, 2020;Keyhanian et al, 2020;Barizien et al, 2021;Becker, 2021;Larsen et al, 2021) such as orthostatic hypotension (OH) or postural orthostatic tachycardia syndrome (POTS) (Blitshteyn and Whitelaw, 2021;Johansson et al, 2021;Raj et al, 2021). In this light, we conducted a cross-sectional observational study on a cohort of participants reporting long COVID symptoms to fulfil the following objectives: (1) establish the prevalence of OI, both during an active stand (AS) test and a tilt test; (2) establish the prevalence of OH and POTS in this cohort; and (3) study haemodynamic and non-haemodynamic predictors of OI.…”

Repeated ethanol exposure and withdrawal alters ACE2 expression in discrete brain regions: Implications for SARS-CoV-2 infection

“…Noradrenergic neurons in the LC have been associated with a wide array of physiological functions including cardiovascular and respiratory control (de Carvalho et al, 2017; Oyamada et al, 1998) via direct projections to the spinal cord or projections to autonomic nuclei like the dorsal motor nucleus (DMV) of the vagus, the rostroventrolateral medulla (RVM), the Edinger-Westphal nucleus, the caudal raphe, the paraventricular nucleus, and the amygdala (Samuels and Szabadi, 2008). As autonomic functions are impaired in COVID-19 patients after infection (Becker, 2021; Milovanovic et al, 2021) and the LC is one of the regions that is associated with these functions, we tested ACE2 immunoreactivity in LC neurons after CIE exposure. Many TH-positive neurons in the LC were positive for ACE2 expression as previously reported (Hernández et al, 2021) and the number of TH-ACE2 neurons was increased in CIE mice, suggesting an increased vulnerability of LC neurons to SARS-CoV-2 infection.…”