Clinical Review of Dysautonomia and its Contribution to Long COVID and Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome

DOI: 10.5281/zenodo.16049793

ABSTRACT

This podcast examines dysautonomia, a dysfunction of the autonomic nervous system, as a significant factor in both Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). It outlines the definition, classification, and general pathophysiological mechanisms of dysautonomia, with a focus on Postural Orthostatic Tachycardia Syndrome (POTS), and details diagnostic approaches including autonomic function testing. The discussion provides an in-depth analysis of the prevalence, clinical presentation, and pathophysiological underpinnings of dysautonomia in the context of Long COVID and ME/CFS, highlighting overlapping symptoms like fatigue, brain fog, and post-exertional malaise (PEM). It also covers shared mechanisms such as neuroinflammation, autoimmunity, and endothelial dysfunction. Finally, the podcast addresses diagnostic challenges due to symptom overlap and the impact of PEM on testing, and discusses comprehensive management strategies that include non-pharmacological interventions, tailored exercise rehabilitation, and various pharmacological treatments.

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OBJECTIVES

1. What is dysautonomia, and how does it relate to Long COVID and ME/CFS?

2. What are the common manifestations of dysautonomia in Long COVID and ME/CFS, with a focus on POTS?

3. What are the key pathophysiological mechanisms believed to drive dysautonomia in Long COVID and ME/CFS?

4. How do the symptoms of dysautonomia impact key features of Long COVID and ME/CFS, such as fatigue, brain fog, and Post-Exertional Malaise (PEM)?

5. What are the main diagnostic challenges for dysautonomia in Long COVID and ME/CFS, and what tests are typically used?

6. What are the primary non-pharmacological strategies for managing dysautonomia in these conditions?

7. What pharmacological treatments are used for dysautonomia, and are there specific considerations for Long COVID/ME/CFS patients, particularly regarding medication sensitivity?

8. How does treating dysautonomia impact the overall quality of life and functional capacity for individuals with Long COVID and ME/CFS?

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