Therapeutic Approaches to Dysautonomia in Childhood, with a Special Focus on Long COVID.

BACKGROUND: Dysautonomia seems to be important for the pathophysiology of psychosomatic diseases and, more recently, for long COVID. This concept may explain the clinical symptoms and could help open new therapeutic approaches. METHODS: We compared our data from an analysis of heart rate variability (HRV) in an active standing test in 28 adolescents who had developed an inappropriate sinus tachycardia (IST, n = 13) or postural orthostatic tachycardia syndrome (POTS, n = 15) after contracting COVID-19 disease and/or vaccination with 64 adolescents from our database who developed dysautonomia due to psychosomatic diseases prior to the COVID-19 pandemic. We prove the effects of our treatment: omega-3 fatty acid supplementation (O3-FA, n = 18) in addition to propranolol (low dose, up to 20-20-0 mg, n = 32) or ivabradine 5-5-0 mg (n = 17) on heart rate regulation and heart rate variability (HRV). RESULTS: The HRV data were not different between the adolescents with SARS-CoV-2-related disorders and the adolescents with dysautonomia prior to the pandemic. The heart rate increases in children with POTS while standing were significantly lower after low-dose propranolol (27.2 ± 17.4 bpm***), ivabradine (23.6 ± 8.12 bpm*), and O-3-FA (25.6 ± 8.4 bpm*). The heart rate in children with IST while lying/standing was significantly lower after propranolol (81.6 ± 10.1 bpm**/101.8 ± 18.8***), ivabradine (84.2 ± 8.4 bpm***/105.4 ± 14.6**), and O-3-FA (88.6 ± 7.9 bpm*/112.1/14.9*). CONCLUSIONS: The HRV data of adolescents with dysautonomia after COVID-19 disease/vaccination are not significantly different from a historical control of adolescents with dysautonomia due to psychosomatic diseases prior to the pandemic. Low-dose propranolol > ivabradine > omega-3 fatty acids significantly decrease elevated heart rates in patients with IST and the heart rate increases in patients with POTS and may be beneficial in these children with dysautonomia.

Sinus Tachycardia: a Multidisciplinary Expert Focused Review.

Sinus tachycardia (ST) is ubiquitous, but its presence outside of normal physiological triggers in otherwise healthy individuals remains a commonly encountered phenomenon in medical practice. In many cases, ST can be readily explained by a current medical condition that precipitates an increase in the sinus rate, but ST at rest without physiological triggers may also represent a spectrum of normal. In other cases, ST may not have an easily explainable cause but may represent serious underlying pathology and can be associated with intolerable symptoms. The classification of ST, consideration of possible etiologies, as well as the decisions of when and how to intervene can be difficult. ST can be classified as secondary to a specific, usually treatable, medical condition (eg, pulmonary embolism, anemia, infection, or hyperthyroidism) or be related to several incompletely defined conditions (eg, inappropriate ST, postural tachycardia syndrome, mast cell disorder, or post-COVID syndrome). While cardiologists and cardiac electrophysiologists often evaluate patients with symptoms associated with persistent or paroxysmal ST, an optimal approach remains uncertain. Due to the many possible conditions associated with ST, and an overlap in medical specialists who see these patients, the inclusion of experts in different fields is essential for a more comprehensive understanding. This article is unique in that it was composed by international experts in Neurology, Psychology, Autonomic Medicine, Allergy and Immunology, Exercise Physiology, Pulmonology and Critical Care Medicine, Endocrinology, Cardiology, and Cardiac Electrophysiology in the hope that it will facilitate a more complete understanding and thereby result in the better care of patients with ST.

A racing heart post-Pfizer/BioNTech BNT162b2.

Palpitations is one of the most common side effects experienced post-messenger-RNA COVID-19 vaccines. However, some patients experience significant symptoms and further workup needs to be considered. We present an interesting case of inappropriate sinus tachycardia in a fit gentleman who presented with worsening palpitations and elevated heart rate post-first and -second dose of the Pfizer/BioNTech vaccine.

COMPARISON OF THE EFFICACY OF ß BLOCKER AND IVABRADINE IN POST COVID-19 ASSOCIATED INAPPROPRIATE SINUS TACHYCARDIA

Introduction: Covid 19 infection is a recent pandemic which has been linked numerous symptoms post recovery from acute illness. Inappropriate sinus tachycardia[IST] is one of the conditions seen in patients recovered from Covid 19 infection. Currently there is no effective treatment for IST. The present study compares the efficacy of Beta blockers and Ivabradine in controlling the heart rate in IST. Methods: A multi centric prospective study was carried out in 48 patients who developed Post COVID IST for a period of six months. The data was collected and analysed using appropriate statistical test for comparision of minimal, mean, and maximum heart rate at zero, three, and six months. RESULTs: The participants were divided into two random groups. Group A received Metoprolol 50 mg once daily and group B received Ivabradine 5 mg twice daily. Both the groups were followed and then their minimal, mean and maximal heart rate was recorded at zero, three and six months. Both the drugs were found to be effective in decreasing the heart rate with a p value of less than 0.05. Ivabradine was found to be superior than metoprolol in controlling mean heart rate over six months duration with a p value of less than 0.01.Ivabradine also had better effect than metoprolol in controlling maximal heart rate at three months with a p value of less than 0.01 and over six months with a p value of less than 0.001. Conclusion: Treatment of post COVID 19 IST with Ivabradine has shown to improve basal as well as mean heart rate and is more effective than Beta blocker for a long term use. It can be used as a better alternative to Beta blocker who developed its side effects or are intolerant to it. [ FROM AUTHOR] Copyright of Journal of Cardiovascular Disease Research (Journal of Cardiovascular Disease Research) is the property of Journal of Cardiovascular Disease Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Post-COVID-19 Tachycardia Syndrome: A Distinct Phenotype of Post-Acute COVID-19 Syndrome.

In this paper we highlight the presence of tachycardia in post-acute COVID-19 syndrome by introducing a new label for this phenomenon-post-COVID-19 tachycardia syndrome-and argue that this constitutes a phenotype or sub-syndrome in post-acute COVID-19 syndrome. We also discuss epidemiology, putative mechanisms, treatment options, and future research directions in this novel clinical syndrome.