Key steps for diagnosis and management of orthostatic tachycardia after COVID-19 imperialcollege UniversityLeeds UniofOxford diagnosis heart longcovid COVID19 covid coronavirus
By Dr. Chinta SidharthanMar 10 2023Reviewed by Danielle Ellis, B.Sc. A recent article published in BMJ discussed the prevalence, assessment, and practice pointers for the management of presentations of tachycardia among long coronavirus disease .
Patients with long COVID could present with palpitations or tachycardia, accompanied by dyspnea, dizziness, sweating, fatigue, chest pain, and bloating related to dysautonomia. The varied presentation of long COVID symptoms, the lack of clarity about the pathogenesis, and the absence of approved treatment methods have made long COVID-related tachycardia difficult to diagnose and manage.
Diagnosing orthostatic tachycardia requires excluding conditions such as orthostatic hypertension and other tachycardia precipitants such as fever, dehydration, sepsis, anemia, hypothyroidism, cardiac conditions, pulmonary embolism, and Addison’s disease. While some patients who attend long COVID clinics do not meet these criteria, the tachycardic symptoms presented are similar, and they respond to the management strategies recommended for orthostatic tachycardia.
Presentations and assessment The authors described three case histories where patients presented with orthostatic tachycardia. In one case, the patient experienced palpitations upon standing, unambiguously diagnosed as orthostatic tachycardia. In the second case, while the patient did experience palpitations, cardiorespiratory symptoms were predominant. Tachycardia was diagnosed only after determining that the symptoms were precipitated by standing and not by exertion.
The pharmaceutical options include α and β-blockers, ivabradine , anticholinesterase inhibitors, peripheral vasoconstrictors, and volume expanders. The article presented details on how these drugs work and the conditions in which they can be prescribed.
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