Post-Acute Sequelae of COVID-19 and Cardiovascular Autonomic Dysfunction: What Do We Know?

Post-acute sequelae of SARS-CoV-2 (PASC), or long COVID syndrome, is emerging as a major health issue in patients with previous SARS-CoV-2 infection. Symptoms commonly experienced by patients include fatigue, palpitations, chest pain, dyspnea, reduced exercise tolerance, and “brain fog”. Additionally, symptoms of orthostatic intolerance and syncope suggest the involvement of the autonomic nervous system. Signs of cardiovascular autonomic dysfunction appear to be common in PASC and are similar to those observed in postural orthostatic tachycardia syndrome and inappropriate sinus tachycardia. In this review, we report on the epidemiology of PASC, discuss current evidence and possible mechanisms underpinning the dysregulation of the autonomic nervous system, and suggest nonpharmacological and pharmacological interventions to treat and relieve symptoms of PASC-associated dysautonomia.

Cardio Vascular Autonomic Dysfunction in Type 2 Diabetes Patients with Microalbuminuria

Objective: Main objective of this study is to determine the prevalence of cardiovascular autonomic dysfunction in type-2 diabetes patients with microalbuminuria. Study Design: Descriptive/ observational study Place and Duration: Study was conducted at Diabetes Hospital Hayatabad Peshawar and Mukhtar A Sheikh Hospital Multan for duration of six months from September, 2019 to February, 2020. Methods: Total 70 patients of both genders diagnosed diabetes 2 mellitus were presented in this study. Patients were aged between 20-80 years. Patients’ details demographics were recorded after taking written consent. Prevalence of cardiovascular autonomic dysfunction with microalbuminuria was assessed by statistical analysis. Microalbuminuria was diagnosed among patients if urinary albumin excretion was >30-300mg/g and graded into mild, moderate and severe according to value of urinary albumin excretion was (20–50 mg/24 hr, 50–100 mg/24 hr, 100–300 mg/24 hr). Complete data was analyzed by SPSS 20.0 version. Results: Out of 70, 38 (54.3%) were males and 32 (45.7%) were females. Mean age of the patients were 49.71±17.8 years with mean BMI 28.41±9.42 kg/m2. Mean ACR of microalbuminuria was 166.7±47.8 mg/gm. Among 70 cases, mild microalbuminuria was found in 28 (40%) cases, moderate microalbuminuria was among 31 (44.3%) and 11 (15.7%) was severe microalbuminuria. Lethargy was the most common symptom found in 25 (35.7%) followed by anorexia 20 (28.6%). Frequency of Cardiac autonomic neuropathy was 58 (82.86%), Parasympathetic dysfunction found in 59 (84.3%) and sympathetic dysfunction was among 62 (88.6%). Conclusion: We concluded in this study that the cardiovascular autonomic dysfunction in type-2 diabetes patients highly associated with microalbuminuria with increased systolic diastolic pressure and heart rate. Keywords: Microalbuminuria, Type 2 Diabetes, Cardio autonomic dysfunction

Abstract 12919: Quantitative Assessment of Cardiovascular Autonomic Impairment in Cancer Survivors: A Single Center Experience

Background: Cardiovascular autonomic dysfunction in cancer survivors is poorly understood. Objectives: To better characterize the clinical characteristics and types of autonomic dysfunction in this population. Methods: A retrospective analysis of cancer survivors within an academic cardio-oncology program referred for suspected autonomic dysfunction was performed. Autonomic reflex testing of adrenergic, cardiovagal, and sudomotor function was done. Patients with pre-existing autonomic dysfunction prior to their cancer diagnosis were excluded. Results: Of approximately 282 patients in the UCLA Cardio-Oncology program, twenty-four patients met the inclusion criteria. Twenty-two had autonomic impairment on autonomic reflex testing. Eight patients were female, and the mean age at time of autonomic testing was 51.3 years. The average duration from cancer diagnosis to autonomic testing was 10.3 years. The reasons for referral included dizziness, tachycardia, palpitations, and syncope. The majority of patients (75%) had hematologic disorders. The most common chemotherapies administered were vinca alkaloids (54.2%), alkylating agents (66.7%), and anthracyclines (54.2%). Most patients received radiation to the thorax (66.7%) and neck (53.3%). Eleven patients had mild autonomic impairment, seven had moderate, and four had severe autonomic impairment. Dysfunction was commonly present in the sympathetic and parasympathetic branches, but most pronounced in the sympathetic system. The majority of patients were diagnosed with orthostatic hypotension (50%), inappropriate sinus tachycardia (20.8%), and postural orthostatic tachycardia syndrome (12.5%) and had subjective improvement with treatment. Conclusion: Cardiovascular autonomic dysfunction occurs in cancer survivors, and commonly affects both the sympathetic and parasympathetic systems. Symptom recognition in patients should prompt autonomic testing and treatment where appropriate.