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Chronotropic Incompetence in Non-Hospitalized Patients with Post-COVID-19 Syndrome, 2021, Jimeno-Almazán et al

Discussion in 'Long Covid research' started by Andy, Nov 28, 2021.

  1. Andy

    Andy Committee Member

    Hampshire, UK

    Patients recovering from COVID-19 commonly report persistence of dyspnea, exertional fatigue, and difficulties in carrying out their daily activities. However, the nature of these symptoms is still unknown. The purpose of the study was to identify limiting causes of cardiopulmonary origin for the performance of physical exercise in post-COVID-19 condition that could explain the symptomatic persistence of dyspnea or fatigue-related symptoms.

    Thirty-two non-hospitalized patients with post-COVID-19 condition (i.e., still presenting a chronic symptomatic phase lasting >90 days since debut of symptoms that lasted for at least 2 months and cannot be explained by an alternative diagnosis) completed a clinical examination including echocardiography, submaximal and maximal cardiorespiratory fitness tests (Ekblom-Bak and Bruce’s protocols), and a battery of validated questionnaires about fatigue and exercise intolerance. Four participants (12.5%) reported an abnormal cardiac response to exercise during the submaximal test, which aroused suspicion of the presence of chronotropic incompetence. All of them were confirmed with a positive diagnosis maximal exercise test after cardiology screening, even with a comprehensive clinical examination, resting ECG, and echocardiogram, without other findings. No statistical differences were found in any physiological variables or questionnaire values, between patients with positive and negative diagnoses.

    Chronotropic incompetence and other autonomic disorders may appear in patients with mild forms of COVID-19 presentation and may persist in the long term, being responsible for exercise intolerance after resolution of acute infection. Clinicians should be aware that chronotropic incompetence and other autonomic disorders may be a complication of COVID-19 and should consider appropriate diagnostic and therapeutic interventions in these patients, especially when early exercise-related fatigability is reported.

    Open access, https://www.mdpi.com/2077-0383/10/22/5434/htm
  2. ola_cohn

    ola_cohn Established Member (Voting Rights)

    This was interesting to me because it seems like the opposite of what I would expect.

    Chronotropic incompetence (CI) is generally defined as the inability to increase the heart rate (HR) adequately during exercise to match cardiac output to metabolic demands.

    For me with POTS, my problem is that my heart rate sky rockets with the slightest exertion, but it seems like in this study, their hr was hardly going up at all.

    I wonder why that is? Or am I misunderstanding this?
    Hutan, Trish and SNT Gatchaman like this.
  3. Mithriel

    Mithriel Senior Member (Voting Rights)

    People who have been monitoring their heart rate for a few years have noticed that their heart rate increases due to POTS and due to over exertion, but there are times when it drops or does not rise when they feel particularly bad.

    It may be that at those times there is not enough free energy to power the heart to increase. I usually feel dizzy and very week when it happens and it is a sign for me to do as little as possible.
    Ash and Snowdrop like this.
  4. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

    London, UK
    What they are describing here is unrelated to POTS.
    And only a small minority of their post-Covid patients had it
    SNT Gatchaman and FMMM1 like this.

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