the release of stress-related hormones,
especially epinephrine and norepinephrine,
which can cause rapid heart rate and
breathlessness. This may be followed by
parasympathetic overcompensation, which
causes systemic vasodilation, hypotension,
and possible fainting.
Some researchers suggest the virus
destroys neurons in the central and
peripheral nervous systems, which has
negative consequences on heart function.
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All this is complicated by the fact that
many COVID-19 patients sustain damage to
myocardial cells, so symptoms of problems
in heart function could be neurological,
muscular, or both.
TYPES AND CLASSIFICATIONS
Dysautonomia can be classified in various
ways. Primary disease occurs without
any underlying condition; secondary
dysautonomia is a symptom or complication
of some other condition. It is also
discussed as being either localized, where
the autonomic dysfunction affects only
certain organs and tissues, or systemic,
involving the whole body. Forms of
localized dysautonomia might include
complex regional pain syndrome (in
which an injury leads to a sustained and
ultimately intractable localized sympathetic
response and subsequent tissue damage),
diabetic neuropathy of the vagus nerve
(where diabetes causes nerve damage that
impacts much of parasympathetic control
to the thoracic and abdominal organs),
and some others. However, this discussion
will focus mainly on types of systemic
dysautonomia, which affects whole-
body function. See the sidebar on page
75 for a list of types of dysautonomia.
SIGNS AND SYMPTOMS
The signs and symptoms of dysautonomia
obviously vary, but they look stunningly
like the signs and symptoms of long
COVID. Here is a short list:
• Balance problems
• Blurred vision
• Brain fog
• Chest pain
• Constipation
• Exercise intolerance
• Fatigue that is not relieved by rest
• Heart palpitations, tachycardia
• Lack of sweating, too much sweating
• Migraines, frequent headaches
• Mood swings
Some experts suggest the virus in the
CNS induces dysregulation of heart rate
variability, and that, along with suppressed
respiratory drive, can lead to hypoxia,
fatigue, and chest pain: all common features
of long COVID.
Another possibility is that the infection
may create a new autoimmune response,
which is responsible for the sympathetic
activation of inflammatory reactions, like
the cytokine storms that cause so much
damage in acute infections. Sympathetic
nervous system disruption may also cause
Resources
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Barizien, N. et al. "Clinical Characterization of Dysautonomia in Long
COVID-19 Patients." Scientific Reports 11, no. 1 (2021): 14042.
https://doi.org/10.1038/s41598-021-93546-5.
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https://emedicine.medscape.com/article/1154266-overview.
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Information Page." Accessed December 2021. www.ninds.nih.gov/
Disorders/All-Disorders/Dysautonomia-Information-Page.
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dysautonomia-familial.
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Dysfunction." StatPearls [Internet]. Updated October 9, 2021.
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The Dysautonomia Project. "Mast Cell Activation." Accessed December 2021.
www.thedysautonomiaproject.org/mast-cell-activation.