Chronotropic Incompetence in Non-Hospitalized Patients with Post-COVID-19 Syndrome

Patients recovering from COVID-19 commonly report persistence of dyspnea, exertional fatigue, and difficulties in carrying out their daily activities. However, the nature of these symptoms is still unknown. The purpose of the study was to identify limiting causes of cardiopulmonary origin for the performance of physical exercise in post-COVID-19 condition that could explain the symptomatic persistence of dyspnea or fatigue-related symptoms. Thirty-two non-hospitalized patients with post-COVID-19 condition (i.e., still presenting a chronic symptomatic phase lasting >90 days since debut of symptoms that lasted for at least 2 months and cannot be explained by an alternative diagnosis) completed a clinical examination including echocardiography, submaximal and maximal cardiorespiratory fitness tests (Ekblom-Bak and Bruce’s protocols), and a battery of validated questionnaires about fatigue and exercise intolerance. Four participants (12.5%) reported an abnormal cardiac response to exercise during the submaximal test, which aroused suspicion of the presence of chronotropic incompetence. All of them were confirmed with a positive diagnosis maximal exercise test after cardiology screening, even with a comprehensive clinical examination, resting ECG, and echocardiogram, without other findings. No statistical differences were found in any physiological variables or questionnaire values, between patients with positive and negative diagnoses. Chronotropic incompetence and other autonomic disorders may appear in patients with mild forms of COVID-19 presentation and may persist in the long term, being responsible for exercise intolerance after resolution of acute infection. Clinicians should be aware that chronotropic incompetence and other autonomic disorders may be a complication of COVID-19 and should consider appropriate diagnostic and therapeutic interventions in these patients, especially when early exercise-related fatigability is reported.

Autonomic Disorders

A practical but arbitrary classification of autonomic disorders is used at Mayo Clinic. Presented in a modified and abbreviated form in this chapter, that classification serves to organize and provide an overview of autonomic disorders. It is organized by anatomical systems and levels, although some syndromes and disorders do not fit neatly into this organization and therefore are assigned their own category. This classification quickly shows how abundant and interspersed autonomic dysfunction is among various categories of neurologic disease. Therefore, the role of this chapter is not to describe every disorder that can be associated with autonomic dysfunction. Rather, the chapter focuses on disorders with autonomic dysfunction as a predominant or important feature and thereby covers what are generally referred to as autonomic disorders.

A case of postapoplectic hemichorea with sensory and autonomic disorders

Th. Dosuzkov and Ed. Bena (Revue v. Neurologii i psychiatrii, 1928, nos. 3 and 4). Choreic contractions were noted in the right half of the face and right limbs. These contractions decreased under the influence of volitional tension, increased with distraction of attention, with emotions and unpleasant peripheral sensations. On the right side, the patient had friendly motions of the imitation type, muscle hypotonia, absence of setting reflexes, the presence of tactile hypeesthesia and decreased vibration sensitivity on the right side, miosis and increased sweating on the right.

Means of occupational therapy in (individual) rehabilitation programs for people with Parkinson’s disease

The aim of the work is to develop a set of rehabilitation measures including occupational therapy classes for Parkinson’s disease and to assess the objective condition of patients on the scales of non-motor symptoms, cognitive and mental disorders. Materials and methods. The study of patients was conducted on the basis of anamnesis, objective examination and scales for assessment of non-motor symptoms, cognitive and mental disorders (scale of non-motor symptoms – NMSS, scale of mental disorders – MMSE, Montreal scale of cognitive disorders – MOCA); to assess non-motor symptoms, a patient questionnaire was additionally used to identify autonomic disorders (according to A. M. Wayne, 1998). The control and experimental groups were offered exercise, physiotherapy, massage and nutrition (diet). Occupational therapy was added for the experimental group. Results. After the physical rehabilitation, the condition of the patients significantly improved. The final score in the experimental group of patients with non-motor manifestations of Parkinson’s disease on the scale of assessment of non-motor symptoms was statistically significantly lower and was 61.04 ± 0.39 (P < 0.01). The final score on the scale of mental disorders was statistically significantly higher – 27.78 ± 0.27 (P < 0.01), on the scale of cognitive changes, it also became statistically significantly higher – 25.13 ± 0.19 (P < 0.01). According to A. M. Wayne’s questionnaire of autonomic disorders, the total score in the control group was 64.0 ± 3.2. In the experimental group of patients, the total score was 51.0 ± 5.4 points (P < 0.01). Thus, under the influence of additional occupational therapy classes, in the experimental group both on the scale of non-motor symptoms and by A. M. Wayne’s, questionnaire there was a statistically significant improvement in the condition of patients. Conclusions. Based on the results of the study, it can be concluded that there is a significant difference (P < 0.01) in the condition of patients on the final scores, with the pronounced improvement in the condition of the experimental group patients in comparison with the control group patients, following the results of all survey scales. A significant difference is observed on the scale of non-motor symptoms. A certain role in improving the condition of patients with appropriate screening using study scales and a patient questionnaire to identify autonomic disorders (according to A. M. Wayne, 1998), apparently played a component of the rehabilitation program, which further included occupational therapy classes.

Intravenous Cyclophosphamide Treatment for Systemic Lupus Erythematosus with Severe Autonomic Disorders Confirmed by Head-Up Tilt Table Test: A Case Series

Autonomic disorders are common in patients with SLE, but the therapeutic strategy and methods for evaluating the effects of therapy have not been established. We describe the three cases of SLE patients who developed severe autonomic disorders as demonstrated by the head-up tilt table test (HUT). All three patients were treated by intensive immunosuppressive treatments including cyclophosphamide (IVCY); their HUT results all became negative. Our cases suggest that IVCY treatment can be a good therapeutic option for severe autonomic disorders in SLE patients. The HUT is a useful objective method for the diagnosis of and the evaluation of longitudinal therapeutic effects on autonomic disorders in SLE patients with orthostatic intolerance.

Effectiveness of transcranial magnetic stimulation of the prefrontal cortex for the correction of autonomic disorders in miners with polyneuropathy

Introduction. Polyneuropathy is the most common occupational neurological pathology. Violation of the activity of the central links of autonomic regulation due to excessive afferent impulses from the receptors of the skin and other tissues of the extremities leads to sympathetic activation and angiospasm, the progression of polyneuropathy. A decrease in the parasympathetic influence is the cause of systemic trophic disturbances. The possibility of transcranial magnetic stimulation of the prefrontal cortex opens up new therapeutic opportunities to correct the autonomic disorders in occupationally caused polyneuropathy. The aim of the study was to evaluate the effect of transcranial magnetic stimulation of the dorsolateral zone in the prefrontal cortex of the right hemisphere for the correction of neuroautonomic disorders in miners with polyneuropathy. Material and methods. Forty-two miners of the Kuzbass coal mines with a proven diagnosis of upper extremity polyneuropathy were examined. To identify autonomic dysregulation, the “Questionnaire for revealing the signs of autonomic changes”, spectral and nonlinear indices of cardio rhythm were used. Low-frequency (1 Hz) transcranial magnetic stimulation of the dorsolateral zone of the prefrontal cortex of the right hemisphere was performed in the course of 5 procedures according to a specially elaborated methodology. Results. In the examined miners, a decrease in the nonlinear and spectral indices of heart rate variability was initially determined, which indicated reducing adaptive capabilities, an increase in sympathetic influence. After the magnetic stimulation course, there was an improvement in general well-being and normalization of autonomous regulation according to the questionnaire. An increase in the spectral indices of the heart rate variability, more pronounced in the range of very low frequencies, indicated the activation of suprasegmental autonomic centers and an increase in parasympathetic influence. Conclusions. Transcranial magnetic stimulation of the prefrontal cortex effectively corrects autonomic disorders in miners with polyneuropathy and promotes an increase in adaptive capabilities due to the activation of suprasegmental autonomic centres.