Dysautonomia in Children with Post-Acute Sequelae of Coronavirus 2019 Disease and/or Vaccination

Abstract

Long-term health problems such as fatigue, palpitations, syncope, and dizziness are well-known in patients after COVID-19 (post-acute sequelae of coronavirus (PASC)). More recently, comparable problems have been noticed after the SARS-CoV-2 vaccination (post-VAC). The pathophysiology of these problems is not well-understood. Methods: In 38 children and young adults, we tested if these health problems were related to dysautonomia in an active standing test (Group 1: 19 patients after COVID-19; Group 2: 12 patients with a breakthrough infection despite a vaccination; and Group 3: 7 patients after a vaccination without COVID-19). The data were compared with a control group of 47 healthy age-matched patients, as recently published. Results: All patients had a normal left ventricular function as measured by echocardiography. Significantly elevated diastolic blood pressure in all patient groups indicated a regulatory cardiovascular problem. Compared with the healthy control group, the patient groups showed significantly elevated heart rates whilst lying and standing, with significantly higher heart rate increases. The stress index was significantly enhanced in all patient groups whilst lying and standing. Significantly decreased pNN20 values, mostly whilst standing, indicated a lower vagus activity in all patient groups. The respiratory rates were significantly elevated in Groups 1 and 2. Conclusion: The uniform increase in the heart rates and stress indices, together with low pNN20 values, indicated dysautonomia in children with health problems after COVID-19 disease and/or vaccination. A total of 8 patients fulfilled the criteria of postural orthostatic tachycardia syndrome and 9 patients of an inappropriate sinus tachycardia, who were successfully treated with omega-3 fatty acid supplementation and pharmacotherapy.

Long COVID in Children, Adults, and Vulnerable Populations: A Comprehensive Overview for an Integrated Approach

“…Cardiovascular manifestations of long COVID in children in order of frequency are orthostatic intolerance [61], exercise intolerance, chest pain, and a variation in heart rate, while palpitations are less common [2,[61][62][63].…”

Telemonitoring bei pädiatrischem Post-COVID-Syndrom

“…Oft geht das PCS mit einer autonomen Dysregulation wie z. B. einem posturalen orthostatischen Tachykardiesyndrom (PoTS) 15 , 16 einher. Auch ein Mastzellaktivierungssyndrom (MCAS) kann auftreten 17 .…”

Long COVID in Children: A Multidisciplinary Review

“…Clinical manifestations similar to POTS have been described in adult patients with Long COVID syndrome, underlying a possible common pathogenic pathway [ 81 ]. Few cases of POTS have been described among adolescents with previous SARS-CoV-2 infection, with symptoms including light-headedness, palpitations, fatigue and generalised weakness [ 82 , 83 ]. The exact mechanism at the basis of POTS is still debated.…”

“…Paediatric studies showed abnormally elevated levels of vasodilating hormones (such as nitric oxide, hydrogen sulphide and C-natriuretic peptide) when upright, causing splanchnic and lower extremities venous pooling [ 80 ]. In PASC-affected patients, POTS might be caused by autoantibodies against G-coupled receptors, as demonstrated in adult cases [ 82 ]. The therapeutic approach ranges from oral medications such as β-blockers or vasopressors (i.e., midodrine) to intravenous periodic infusions of normal saline for unresponsive patients [ 80 ].…”