Table 1.
Symptom profile of individuals attending our clinic with autonomic symptoms following viral infection during the COVID-19 pandemic
| Patient | Symptoms | Timing of antecedent illness | Observations in clinic | Other investigations | Clinical diagnosis |
|---|---|---|---|---|---|
| 26-year-old female | Palpitations on standing Dyspnoea Fatigue | Gastrointestinal symptoms 5 days prior to symptoms (suspected viral illness) | Postural BP 104/82 to 120/79 mmHg Postural HR 121–150 bpm | Echocardiogram normal ECG normal | Viral induced postural orthostatic tachycardia syndrome |
| 43-year-old female | Palpitations Fatigue Breathlessness | Upper respiratory tract symptoms 1 month previously (suspected COVID-19) | Postural BP 121/92 to 129/96 mmHg Postural HR 86–106 bpm | Ambulatory BP monitor: average BP 101/66 mmHg 24-hour Holter: sinus rhythm, HRB 68–159, average 86 bpm. Diurnal sinus tachycardia | Viral induced reactive tachycardia, with sympathetic overactivity |
| 50-year-old female | Palpitations Chest pain | Chesty cough March 2020 (suspected COVID-19) | Postural BP 136/48 to 115/91 mmHg Postural HR 48–60 bpm | 24-hour Holter: sinus rhythm, rate 37–134 bpm, average 51 bpm | Post viral orthostatic intolerance |
| 30-year old female | Aches Dizziness Diarrhoea Dizziness and palpitations | Flu-like symptoms March 2020 (confirmed COVID-19) | Postural HR 80–118 bpm Postural BP 112/79 to 123/103 mmHg | Head-up tilt: starting BP 106/69 and HR 67 bpm, BP 72/52 mmHg and HR 99 bpm after 14 minutes | Post viral orthostatic intolerance with reactive tachycardia |
| 50-year-old female | Recurrent presyncopal episodes Fatigue Panic attacks | Suspected COVID-19 infection March 2020 | Postural HR 88–113 bpm Postural BP 137/85 mmHg to 122/88 mmHg | Echocardiogram normal Ambulatory BP monitor: average 101/65 mmHg; Holter monitor: sinus tachycardia Head up tilt: postural drop of 17 mmHg and HR rise to 132 bpm after 24 minutes | Orthostatic intolerance with a tendency to vasovagal presyncope |
| 44-year-old female | Dizziness on walking Fatigue Irritable bowel symptoms Anxiety | Upper respiratory tract symptoms for 5 weeks in March 2020 (suspected COVID-19) | Telephone consultation so only readings from patient's BP monitor: 88/67 mmHg | Nil | Orthostatic intolerance |
BP = blood pressure; bpm = beats per minute; ECG = electrocardiogram; HR = heart rate.