SARS-CoV-2 Infections Can Cause Cardiovascular Autonomic Dysfunction


A new study by European researchers have found that SARS-CoV-2 infections can lead to cardiovascular autonomic dysfunction in many.

The study findings were published in the peer reviewed European Journal of Neurology.

Almost three years  after  the begin of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, the scientific community has gained insights into most of its possible clinical complications both in the acute phase and on the long-term of this post- viral condition which is commonly referred to as post-COVID-19 syndrome.1,2

Neurological complications of an acute coronavirus disease 2019 (COVID-19) are commonly recognized immune-mediated, peri-, para-  and post-infectious neurological syndromes affecting both the peripheral and central nervous system.3 In addition, there is increased risk for cerebrovascular disease, including hemorrhagic stroke and subarachnoid hemorrhage.4

Post-COVID-19, on the other hand, refers to the residual symptoms of an ongoing SARS-CoV-2 infection that persists for more than four weeks, or to newly developed symptoms within three months after such infection, that cannot be explained by other conditions.5

Fatigue, orthostatic intolerance, impaired cognitive performance, shortness of breath, chest pain, and palpitations are persistent symptoms commonly experienced by people with a post-COVID-19 syndrome.6

Neurological signs and symptoms triggered by SARS-CoV-2 have been postulated to depend upon the inflammatory response of the body to the SARS-CoV-2 infection.7 A close, bidirectional relationship in fact exists between changes in the autonomic nervous system and immune system activation, based on multiple neuronal and non-neuronal pathways.

Cytokines and other immunological factors modulate, for example, the activation of autonomic reflex arches, which in turn influence  peripheral immune responses and  various signaling mechanisms, including neurotransmitters, neuromodulators  and  the behavior of specific adrenergic receptors.8

In this context, the cardiovascular autonomic domain appears to be particularly vulnerable to the effects of a SARS-CoV-2 infection.9,10

Early case reports and short series addressed symptoms of cardiovascular autonomic dysfunction in both the acute and post-COVID-19 phases, but difficulties in characterizing autonomic signs and symptoms or in performing structured cardiovascular autonomic function assessments may have led to under-reporting.11,12

For example,  large-scale studies on neurological complications following SARS-CoV-2 infection did not include detailed cardiovascular autonomic assessments, possibly due to the uneven  geographical  distribution of clinical autonomic  laboratories and pandemic-related restrictions in accessing non- emergency neurological care.13-15

Reports of cardiovascular autonomic involvement following COVID-19 infection have been published not only in neurology, but also in internal medicine, general medicine, cardiology and other journals, resulting in a fragmented and incomplete view of the phenomenon.

With the aim of identifying the continuum of cardiovascular autonomic involvement from the acute phase of a SARS-CoV-2 infection to the long haul of the  post-COVID-19  condition, we hereby systematically reviewed all  pre-print  and published  cases of cardiovascular autonomic disorders occurring either in people with acute COVID-19 infections or in the post- COVID-19 phase.


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