A Case Report on Heart Rate Variability Biofeedback and Postconcussion Syndrome: Healing the Autonomic Nervous System

Postconcussion syndrome is a devastating condition of the mind, body, and even personality. Mounting research demonstrates that heart rate variability biofeedback can help the concussed individual in three critical ways: (a) eliciting high amplitude oscillations in cardiovascular functions and thereby strengthening self-regulatory control mechanisms;(b) restoring autonomic balance;and (c) increasing the afferent impulse stream from the baroreceptors to restore balance between inhibitory and excitatory processes in the brain.

Heart Rate Variability and Pregnancy Complications: Systematic Review.

BACKGROUND: The autonomic nervous system (ANS) is known as a critical regulatory system for pregnancy-induced adaptations. If it fails to function, life-threatening pregnancy complications could occur. Hence, understanding and monitoring the underlying mechanism of action for these complications are necessary. OBJECTIVE: We aimed to systematically review the literature concerned with the associations between heart rate variability (HRV), as an ANS biomarker, and pregnancy complications. METHODS: We performed a comprehensive search in the PubMed, Medline Completion, CINAHL Completion, Web of Science Core Collection Classic, Cochrane Library, and SCOPUS databases in February 2022 with no time span limitation. We included studies concerned with the association between any pregnancy complications and HRV, with or without a control group. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was used for the review of the studies, and Covidence software was used for the study selection process. For data synthesis, we used the guideline by Popay et al. RESULTS: Finally, 12 studies with 6656 participants were included. Despite the methodological divergency that hindered a comprehensive comparison, our findings suggest that ANS is linked with some common pregnancy complications including fetal growth. However, existing studies do not support an association between ANS and gestational diabetes mellitus. Studies that linked pulmonary and central nervous system disorders with ANS function did not provide enough evidence to draw conclusions. CONCLUSIONS: This review highlights the importance of understanding and monitoring the underlying mechanism of ANS in pregnancy-induced adaptations and the need for further research with robust methodology in this area.

Study of sympathetic skin response in patients with COVID-19 infection.

OBJECTIVES: Many articles hypothesized the potential role of autonomic nervous system in the pathogenesis and outcome of COVID-19 infection. Several studies reported both central and peripheral nervous system involvement in COVID-19 as well. Up to our knowledge, there is no study evaluating whether this virus could invade the autonomic nervous system affecting its function adversely. Sympathetic skin response (SSR) has long been used as a method of evaluating the autonomic nervous system. Regarding the importance of the autonomic nervous system in hemostasis and wide consequences of COVID-19 infection, we designed this study to evaluate the autonomic nervous system function in patients recovered from COVID-19 compared with normal population who are not yet infected by this virus by the means of SSR. METHODS: This case-control study included 70 patients surviving COVID-19 who met the inclusion and exclusion criteria that went under SSR. The data gathered were compared with those without the history of any symptoms attributable to COVID-19 during the pandemic. RESULTS: There was a correlation between COVID-19 infection and abnormal SSR (p value < 0.0001) with the most effect on the latency prolongation of the action potential recorded from the median nerve at palms (effect size: right: 3.90, left: 3.69). Moreover, the greater severity of the disease correlated with more abnormality of parameters recorded by SSR technique. CONCLUSIONS: Abnormal SSR parameters could be a good indicator of autonomic nervous system involvement in patients with COVID-19 infection. It might be a predictor of disease severity, clinical outcomes and prognosis as well.

Imbalance of Peripheral Temperature, Sympathovagal, and Cytokine Profile in Long COVID.

A persistent state of inflammation has been reported during the COVID-19 pandemic. This study aimed to assess short-term heart rate variability (HRV), peripheral body temperature, and serum cytokine levels in patients with long COVID. We evaluated 202 patients with long COVID symptoms categorized them according to the duration of their COVID symptoms (≤120 days, n = 81; >120 days, n = 121), in addition to 95 healthy individuals selected as controls. All HRV variables differed significantly between the control group and patients with long COVID in the ≤120 days group (p < 0.05), and participants in the long COVID ≤120 days group had higher temperatures than those in the long COVID >120 days group in all regions analysed (p < 0.05). Cytokine analysis showed higher levels of interleukin 17 (IL-17) and interleukin 2 (IL-2), and lower levels of interleukin 4 (IL-4) (p < 0.05). Our results suggest a reduction in parasympathetic activation during long COVID and an increase in body temperature due to possible endothelial damage caused by the maintenance of elevated levels of inflammatory mediators. Furthermore, high serum levels of IL-17 and IL-2 and low levels of IL-4 appear to constitute a long-term profile of COVID-19 cytokines, and these markers are potential targets for long COVID-treatment and prevention strategies.

Heart Rate Variability during Virtual Reality Activity in Individuals after Hospitalization for COVID-19: A Cross-Sectional Control Study

(1) Background: COVID-19 can lead to many complications, including cardiorespiratory complications and dysautonomia. This can be assessed by heart rate variability (HRV), which reflects the autonomic nervous system. There are different possibilities for physical rehabilitation after COVID, one of which that has been growing fast is the use of Virtual reality (VR) for rehabilitation. VR may represent an innovative and effective tool to minimize deficits that could lead to permanent disabilities in patients of outpatient rehabilitation services. The aim of this protocol is to establish whether practicing a task using a VR game with body movements influences physiological variables, such as heart rate, HRV, oxygen saturation, blood pressure, and perceptual variables during exercise in individuals post-hospitalization for COVID. (2) Methods: This cross-sectional study evaluated individuals divided into two groups, a post-hospitalization for COVID-19 group and a healthy control group. Subjects underwent one session of a VR task, and physiological variables, including HRV, were measured during rest, VR activity, and recovery. In addition, considering the influence of age in HRV and the impact of COVID-19, we divided participants by age. (3) Results: In all HRV indices and in both groups, an increase in sympathetic and a decrease in parasympathetic activity were found during VR. Additionally, the older post-COVID-19 group performed worse in non-linear indices, peripheral oxygen saturation, and rating of perceived exertion (RPE). (4) Conclusions: The VR game positively affects physiological variables and can therefore be utilized as a secure physical activity in both healthy individuals and individuals after hospitalization for COVID-19. COVID-19 affects the autonomic nervous system of older patients' post-hospitalization, which may be partly due to a higher BMI and the reduced exercise capacity in this population, affecting their ability to perform exercise activities. Other important observations were the higher RPE in COVID-19 patients during and after exercise, which may reflect altered physiological and autonomic responses. Taken together with the high reporting of fatigue after COVID-19, this is an important finding, and considering that RPE is usually lower during VR exercise compared to non-VR strengthens the potential for the use of VR in COVID-19 patients.

COVID-19 and the autonomic nervous system

Background: COVID-19 infection has been shown to have an adverse impact on the cardiovascular system. Cardiac injury, as indicated by elevated cardiac troponin and NT-proBNP levels have been confirmed in COVID-19 cases. There is still ambivalent data on the effect of left ventricular function. Cases of left ventricular impairment, persistent hypotension, acute myopericarditis, myocarditis, arrhythmia and heart failure have been reported in the short term, but there is a significant lacuna when it comes to medium and long-term follow-up of subjects previously infected with COVID-19. Purpose(s): To assess any residual myocardial and autonomic injury in subjects previously infected with COVID-19 at a median follow-up of 5 months. Method(s): A case-control study was performed. Cases were randomly selected subjects who were previously diagnosed with COVID-19 infection following nasopharyngeal swabbing. Controls were subjects who had not been found to be infected with COVID-19 following swabbing and were negative for COVID-19 IgG antibodies. All participants were submitted a standardised questionnaire regarding past medical history. Blood investigations were taken including NT-proBNP and troponin I levels. In addition, all participants underwent 24-hour ambulatory blood pressure monitoring (ABPM) and 24-hour ECG monitoring. The latter was used to assess both for underlying arrhythmias as well as heart rate variability (HRV), a measure of autonomic regulation of the heart. All data was analysed using SPSS version 23.0. Result(s): The study comprised 259 subjects, whereby cases included 174 participants while 75 subjects were age- and gender-matched controls. The study cohort was relatively young with a mean age of 46.1+/-13.8 years. The median follow-up was of approximately 5 months (median 173.5 days, IQR 129-193.25 days). There was no statistically significant difference between cases and controls with regards cardiovascular risk factors and underlying medical conditions. Likewise, there was no difference in blood investigations, including troponin I and NT-proBNP levels at 5-months followup. No difference was noted between the two groups in both awake and asleep blood pressure (BP) readings, as well as dipping BP status. No significant arrhythmias were noted in both groups on 24-hour ECG monitoring. However, when assessing for heart rate variability, it was shown that subjects who had been previously infected with COVID-19 exhibited lower root-mean square differences of successive R-R intervals (RMSSD), p=0.028. This indicates poor vagus nerve-mediated autonomic control of the heart. Conclusion(s): Subjects previously infected with COVID-19 exhibited lower HRV as exhibited by low RMSSD as compared to controls. Reduced HRV is a known biomarker for mortality and sudden death in cardiac disease. The possible long-term implications of reduced HRV in subjects previously infected with COVID-19 merits further investigation.

The contribution of angiotensin peptides to cardiovascular neuroregulation in health and disease

The brain renin–angiotensin system (RAS) is critically involved in the cardiovascular regulation and energy homeostasis. The overwhelming evidence indicates that the central RAS closely cooperates with the systemic RAS by means of interactions with the autonomic nervous system and hormonal and humoral factors linking RAS with regulation of blood pressure, water–electrolyte equilibrium, and energy balance. Particularly significant roles in these interactions are played by aldosterone and vasopressin;however, other factors such as proinflammatory cytokines, growth factors, nitric oxide, prostaglandins, and ROS appear to be also essential players, especially during challenges (stress, hypoxia), and under pathological conditions (hypertension, heart failure, metabolic syndrome, atherosclerosis, COVID-19). Current pharmacotherapies of cardiovascular diseases are focused on the angiotensin-converting enzyme inhibitors and angiotensin type 1 receptor blockers and their effects on systemic RAS. A better understanding of neuroanatomical and neurochemical connections between central RAS and other regulatory systems should advance pharmacological interventions aimed at central RAS. © 2023 Elsevier Inc. All rights reserved.

Compassion focused therapy: An evolutionary and biopsychosocial understanding of depression and its management

Compassion focused therapy (CFT) is an evolution-informed biopsychosocial approach and thereby has sought to explore some of the evolved mechanisms that may underpin depression and how they are activated and regulated throughout the course of a person's life. The essence of a CFT approach is that motivations (social mentalities) regulate multiple functions, and that, when individuals get caught in threat-focused competitiveness and a sense of social isolation and disconnection, they are at risk of stimulating a whole range of psychophysiological states that will move them towards depression states. Depression is often comorbid with many other conditions such as eating disorders, substance abuse, and post-traumatic stress disorder. In regard to the cognitive competencies, depression affects attention, concentration and memory, styles of reasoning, and rumination. There are also multiple changes in the autonomic nervous system and increasing evidence that diets that are 'inflammatory' and can affect the immune system are linked to increasing rates of depression. Sleep difficulties are particularly important and can lead to a spiral of fatigue and depression. Lockdowns associated with Covid-19 have significantly increased the incidence of depression. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Evaluation of cardiovascular autonomic dysfunction in symptomatic post COVID-19 patients

Background: The COVID-19 disease is known for its severe respiratory complications, however it was found to have some cardiovascular complication in post COVID-19 patients. The heart rate variability (HRV) is a non invasive, objective and reliable method for assessment of autonomic dysfunction in those recovered patients. Purpose(s): We aimed to evaluate the cardiac autonomic function by using valid HRV indices in subjects who recovered from mild to moderate acute COVID-19 but still symptomatic. Method(s): The study Group composed of 50 subjects with confirmed history of mild to moderate post COVID 19. All subjects underwent routine 2D echocardiography assessment in addition to 2D speckle tracking and 24 hours Holter monitoring for HRV analysis. Result(s): The mean age of the study population was 42+/-18 years, symptoms were reported as follows 27 (54%) had Dyspnea, 17 (34%) had palpitations, 7 (14%) had dizziness. Time domain parameters SDNN, SDANN and rMSSD were diminished with mean SDNN value being markedly impaired in 12 (24%) patient, while frequency domain parameters as assessed by LF/HF ratio with mean of 1.837 with 8% of patients being impaired. SDNN was significantly reduced in elderly patients (p=0.001), smokers (p=0.019) and hypertensive (p=0.016) and those complaining mainly of palpitation (p=0.006). SDNN was significantly reduced in patient with impaired LV diastolic function (p=0.009), in patients with reduced MAPSE (p=0.047), reduced TAPSE (p=0.00) and impaired Global longitudinal strain (0.000). Conclusion(s): Patients with post COVID-19 syndrome have abnormalities in the HRV which indicates some degree of dysfunction in the autonomic nervous system and consequently impaired parasympathetic function in this population, however this have been also correlating with subtle impairment of the left ventricular systolic function.We believe that this preliminary research can serve a starting point for future research in this direction.

Moderate Aerobic Exercise Reduces the Detrimental Effects of Hypoxia on Cardiac Autonomic Control in Healthy Volunteers.

Physical inactivity increases cardiometabolic risk through a variety of mechanisms, among which alterations of immunological, metabolic, and autonomic control systems may play a pivotal role. Physical inactivity is frequently associated with other factors that may further worsen prognosis. The association between physical inactivity and hypoxia is particularly interesting and characterizes several conditions-whether physiological (e.g., residing or trekking at high altitude and space flights) or pathological (e.g., chronic cardiopulmonary diseases and COVID-19). In this randomized intervention study, we investigated the combined effects of physical inactivity and hypoxia on autonomic control in eleven healthy and physically active male volunteers, both at baseline (ambulatory) conditions and, in a randomized order, hypoxic ambulatory, hypoxic bedrest, and normoxic bedrest (i.e., a simple experimental model of physical inactivity). Autoregressive spectral analysis of cardiovascular variabilities was employed to assess cardiac autonomic control. Notably, we found hypoxia to be associated with an impairment of cardiac autonomic control, especially when combined with bedrest. In particular, we observed an impairment of indices of baroreflex control, a reduction in the marker of prevalent vagal control to the SA node, and an increase in the marker of sympathetic control to vasculature.

Post-COVID-19 Exercise Stress Test

Objectives: Atypical chest pain, fatigue, and palpitations can be seen in post-coronavirus disease-2019 (COVID-19) period. With the hypothesis of explaining these complaints, we evaluated the exercise stress test (EST) parameters in COVID-19 patients with mild disease. Material(s) and Method(s): Between the ages of 30-50 years, who had mild COVID-19 in the last 3-9 months, were taken as the COVID-19 group [n=80, male/female (M/F): 40/40]. A total of 160 patients were included, of which age and gender matched 80 patients (M/F: 40/40) without COVID-19 were the control group. During the EST, baseline heart rate HR1(beats/min), baseline systolic, diastolic blood pressure (mmHg) (SBP1, DBP1), maximum blood pressures (SBPmax, DBPmax), and blood pressure changes (DELTASBP, DELTADBP) were recorded. As EST parameters, Duke score, exercise time (min), ST change (mm), exercise capacity (METs), maximum reached HR (% beats/min), distance walked (m), maximum oxygen consumption amount (VO2max mL/kg/min), rate pressure product (RPP mmHg/min/1000), and heart HR recovery 1 (HRR1 beats/min) was used. Result(s): In the COVID-19 group, baseline HR1, SBP1, DBP1, SBPmax, DBPmax, DELTASBP, DELTADBP, VO2max, and RPP were higher, while distance walked and HRR1 were less. There was no difference between the two groups in terms of Duke score, exercise duration, ST change and exercise capacity. Conclusion(s): The fact that the exercise capacities in the COVID-19 group were similar to those in the control group, but there was a difference in the changes in heart rate and blood pressure, RPP, HRR1 suggested that the autonomic system might be affected.Copyright © 2022 by Heart and Health Foundation of Turkey.

Long-term assessment of autoantibodies in post-COVID syndrome

Novel coronavirus infection remains to be one of the most serious issues of the modern health care, mainly, due to its prevalence and insufficient knowledge of the pathogenesis of this disease and its complications. The autoimmune hypothesis of the post-COVID-19 syndrome is being described in various studies that evaluate autoantibodies to human tissues, many of which have a direct correlation with the COVID-19 symptoms. Among the most promising laboratory findings, the antinuclear, antiphospholipid antibodies, rheumatoid factor, as well as the autoantibodies to the autonomic nervous system are described. Many studies have been tackling the role of the novel coronavirus infection as a trigger for classic autoimmune diseases, but the extent of the virus's influence on rheumatic diseases is still a matter of debate. The identification of autoantibodies and the development of the evidence-based knowledge about their role in the post-COVID-19 syndrome will allow the elaboration of the new recommendations for the diagnosis and treatment of these patients. © 2023 Elsevier Inc. All rights reserved.

Effects of Covid-19 on Autonomic Function Modulation in Young Adults: An Observational Prospective Case-Control Study...American Congress of Rehabilitation Medicine (ACRM) 99th Annual Conference, November 8-11, 2022, Chicago, Illinois

To observe the effects of COVID-19 infection on ANS function over a follow-up period in young adults. Observational prospective case-control study. Subjects were evaluated at baseline and in a follow-up visit six weeks following the first shot of SARS-CoV-2 immunization. Private Physical Therapy ambulatory. Male and female subjects aged 20-40 years with, a diagnosis of mild or moderate clinical COVID-19 with a positive PCR test and slight clinical symptoms, and who were not admitted to intensive care unit. Participants were recruited after a minimum of 15 and a maximum of 120 days of diagnosis (PCOV). An age-matched heathy control group (CG) that was negative for COVID-19 was also recruited. Autonomic nervous system function was measured through heart rate variability (HRV). Heart rate was recorded beat-to-beat to evaluate cardiac autonomic modulation. We used a cardio-frequency meter (Polar RS800CX). Participants were equipped with a chest strap and monitor and remained at rest for 25 minutes. Sympathetic and Parasympathetic indexes through HRV. 57 subjects were evaluated at baseline. After 19 exclusions, 38 subjects with complete data were included in the baseline analysis where 18 subjects were in CT and 20 in the PCOV group. Regarding sympathetic nervous system activity, there was no difference between baseline and follow-up moments within CT or PCOV groups (p>0.05). For intergroup analysis, we observed that PCOV group presents significant higher reductions in sympathetic activity over time when compared to CT demonstrated by HR (p=0.0088) and SNS index (p=0.0068). Observations of parasympathetic nervous system activity reveals a statistical increase between baseline and follow up in Mean RR (p=0.0312) and pNN50 (p=0.0312) for PCOV group. The intergroup analysis revealed that PCOV group presented a significant higher increase in parasympathetic activity overtime demonstrated by mean RR (-44.54±32.38 vs. 60.36±55.35;p= 0.0097) and PNS index (-0.32±0.20 vs. 0.54 ± 0.35;p= 0.0091) when compared to CT. Sympathetic activity decreased in PCOV after infection and over the follow up period. Authors declare no conflicts.

Effect Of Rosuvastatin In The Protection Against Azithromycin Induced Cardiotoxicity In Covid-19 Patients: A One-Year Prospective Study

Background Azithromycin is a widely used broad-spectrum antibiotic that was recently used in the treatment protocol of COVID-19 but its cardiac side effects became a more prominent concern. Rosuvastatin is a synthetic statin that showed anti-inflammatory, antioxidant and autonomic nervous system regulatory effects in addition, there is increasing evidence supporting that it could play a beneficial role in patients with COVID-19. Objective To evaluate the protective effect of Rousvastatin against Azithromycin-induced cardiotoxicity in Covid-19 patients. Patients and Methods This is a prospective study that was conducted on adult patients diagnosed with COVID-19 who were admitted to isolation centres in Minia Governorate, Egypt for the period of one year (June 2021 to May 2022). The study included a total of 80 COVID-19 patients who were divided into 2 groups (n=40 each), group (I) "Azithromycin group" that included patients received Azithromycin (500 mg/day for 5 days) orally and group (II) "Azithromycin + Rosuvastatin group" that included patients received Azithromycin by oral route as group (I) plus Rosuvastatin 20 mg/day orally. All included cases were subjected to full history taking, clinical examination and laboratory investigations and after treatment, the outcome measures were reported and compared. Results No significant differences were observed between groups regarding demographic and baseline characteristics. Also, the two groups were comparable with no significant differences in pulse rate, blood sugar, CBC, electrolyte elements, liver enzymes, and kidney function (a slight reduction was noticed in group II). While, Ferritin level was significantly lower in group (II) compared to group (I), (830 ± 72.5 vs. 865 ± 69.5, p=0.03). No significant differences were observed among groups as regards Troponin level (p=0.56) "Only one case was positive in group (I)". Both groups were almost comparable without significant differences in both stages of infection and mortality (p=0.38 and 1.0, respectively). Conclusion Rosuvastatin did not have a significant role in the protection of Azithromycin-induced cardiotoxicity, it slightly ameliorates the biochemical and stress markers alterations of Azithromycin. Further larger studies are warranted for investigating this issue. [ FROM AUTHOR] Copyright of Journal of Pharmaceutical Negative Results is the property of ResearchTrentz 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.)

Relationships between sensory reactivity, restricted and repetitive behaviors, and autonomic nervous system activity in autistic and non-autistic individuals

The current dissertation includes seven chapters. Chapter 1 includes my professional background and describes the experiences that led me to study restricted and repetitive behaviors. It also briefly describes my personal journey as an international graduate student. Chapter 2 is devoted to the rich literature that this dissertation is based on. The literature review covers both the foundational and most recent findings in the fields of sensory reactivity, restricted and repetitive behaviors, and autonomic activity, as well as the known relationships between these areas in autistic and non-autistic individuals. In Chapter 3, I describe in detail the methodology used in the current dissertation, including a description of the participants and the study design and analysis choices. Chapters 4 through 6 describe three experimental studies examining different aspects of the relationships between sensory reactivity, restricted and repetitive behaviors, and autonomic activity. Chapter 4 presents findings from a study conducted with both children and adults examining the pupil light reflex as it relates to levels of autistic traits in both age groups. Chapter 5 presents findings from a remote questionnaire study using caregiver-report measures that examines the relationships among sensory reactivity, restricted and repetitive behaviors, and adaptive behaviors in non-autistic children. Chapter 6 extends the questionnaire study of Chapter 5, presenting findings from an in-person study with a subset of children (limited due to restrictions related to COVID-19) that aimed to examine the role of autonomic activity in the relationship between sensory reactivity and restricted and repetitive behaviors in order to begin uncovering the potential mechanisms underlying this relationship. Finally, Chapter 7 is devoted to an overarching conclusion, potential implications, and a description of future plans for my own line of research, which include examining new questions in autistic populations and then extending these questions into the general, broader, population. The motivation behind the research presented in this dissertation is to better understand behaviors that are associated with and prevalent in autism and are also highly stigmatized. Research showing that autistic traits vary widely in the general population can speak to and contribute to the increasing awareness and acceptance of the autistic experience, which is just different, not less. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Prefrontal tDCS modulates autonomic responses in COVID-19 inpatients.

BACKGROUND: maladaptive changes in the autonomic nervous system (ANS) have been observed in short and long-term phases of COVID-19 infection. Identifying effective treatments to modulate autonomic imbalance could be a strategy for preventing and reducing disease severity and induced complications. OBJECTIVE: to investigate the efficacy, safety, and feasibility of a single session of bihemispheric prefrontal tDCS on indicators of cardiac autonomic regulation and mood of COVID-19 inpatients. METHODS: patients were randomized to receive a single 30-min session of bihemispheric active tDCS over the dorsolateral prefrontal cortex (2 mA; n = 20) or sham (n = 20). Changes in time [post-pre intervention] in heart rate variability (HRV), mood, heart rate, respiratory rate, and oxygen saturation were compared between groups. Additionally, clinical worsening indicators and the occurrence of falls and skin injuries were evaluated. The Brunoni Adverse Effects Questionary was employed after the intervention. RESULTS: there was a large effect size (Hedges' g = 0.7) of intervention on HRV frequency parameters, suggesting alterations in cardiac autonomic regulation. An increment in oxygen saturation was observed in the active group but not in the sham after the intervention (P = 0.045). There were no group differences regarding mood, incidence and intensity of adverse effects, no occurrence of skin lesions, falls, or clinical worsening. CONCLUSIONS: a single prefrontal tDCS session is safe and feasible to modulate indicators of cardiac autonomic regulation in acute COVID-19 inpatients. Further research comprising a thorough assessment of autonomic function and inflammatory biomarkers is required to verify its potential to manage autonomic dysfunctions, mitigate inflammatory responses and enhance clinical outcomes.

Impact of the COVID-19 pandemic on clinical autonomic practice in Europe A survey of the European Academy of Neurology (EAN) and the European Federation of Autonomic Societies (EFAS).

OBJECTIVE: To investigate the impact of the coronavirus-disease-2019 (COVID-19) pandemic on European clinical autonomic practice. METHODS: Eighty-four neurology-driven or interdisciplinary autonomic centers in 22 European countries were invited to fill in a web-based survey between September and November 2021. RESULTS: Forty-six centers completed the survey (55%). During the first pandemic year, the number of performed tilt-table tests, autonomic outpatient and inpatient visits decreased respectively by 50%, 45% and 53%, and every-third center reported major adverse events due to postponed examinations or visits. The most frequent newly-diagnosed or worsened cardiovascular autonomic disorders after COVID-19 infection included postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension, and recurrent vasovagal syncope, deemed likely related to the infection by ≥50% of the responders. Forty-seven percent of the responders also reported about people with new-onset of orthostatic intolerance, but negative tilt-table findings, and 16% about people with psychogenic pseudosyncope after COVID-19. Most patients were treated non-pharmacologically and symptomatic recovery at follow-up was observed in ≥45% of cases. By contrast, low frequencies of newly-diagnosed cardiovascular autonomic disorders following COVID-19 vaccination were reported, most frequently POTS and recurrent vasovagal syncope, and most of the responders judged a causal association unlikely. Non-pharmacological measures were the preferred treatment choice, with 50-100% recovery rates at follow-up. CONCLUSIONS: Cardiovascular autonomic disorders may develop or worsen following a COVID-19 infection, while the association with COVID-19 vaccines remains controversial. Despite the severe pandemic impact on European clinical autonomic practice, a specialized diagnostic work-up was pivotal to identify non-autonomic disorders in people with post-COVID-19 orthostatic complaints.

Post-acute sequelae of SARS-CoV-2 syndrome presenting as postural orthostatic tachycardia syndrome.

The novel SARS-CoV-2 emerged in 2019, and the global COVID-19 pandemic continues into 2022. It has been known that a subset of patients develops chronic, debilitating symptoms after otherwise complete recovery from acute infection of COVID-19. Multiple terms have been used to describe this constellation of symptoms, including long COVID, long-haul COVID, and postacute sequelae of SARS-CoV-2 syndrome (PASC). PASC is broadly defined as a wide range of new, returning, or ongoing symptoms at least four weeks after infection. Those patients are often seen in emergency departments after acute COVID-19 infection, but their symptoms are not adequately managed because the underlying pathophysiology of PASC is not well understood. Among patients with PASC, postural orthostatic tachycardic syndrome (POTS) has been increasingly recognized. POTS is one of the most common forms of autonomic dysfunction and defined by a sustained orthostatic tachycardia during active standing or head-up tilt test in the absence of orthostatic hypotension or other cardiopulmonary diseases. Because POTS is a treatable condition, it is important to recognize POTS among PASC patients. Herein, we reviewed the current literature on POTS and dysautonomia in PASC in order to better understand the overlap and distinction between these pathologies.

Heart Rate Variability in Subjects with Severe Allergic Background Undergoing COVID-19 Vaccination.

Anti-Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccination is the world's most important strategy for stopping the pandemic. Vaccination challenges the body's immune response and can be complicated by hypersensitivity reactions. The autonomic nervous system can modulate the inflammatory immune response, therefore constituting a potential marker to characterize individuals at high risk of hypersensitivity reactions. Autonomic nervous system functionality was assessed through measurement of the heart rate variability (HRV) in subjects with a history of severe allergic reactions and 12 control subjects. HRV parameters included the mean electrocardiograph RR interval and the standard deviation of all normal R-R intervals (SDNN). All measurements were performed immediately before the anti-SARS-CoV-2 vaccination. The median RR variability was lower in the study than in the control group: 687 ms (645-759) vs. 821 ms (759-902); p = 0.02. The SDNN was lower in the study group than in the control group: 32 ms (23-36) vs. 50 ms (43-55); p < 0.01. No correlation was found between age and the SDNN. Autonomic nervous system activity is unbalanced in people with a severe allergy background.