Chronotropic Incompetence in Non-Hospitalized Patients with Post-COVID-19 Syndrome
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 pe...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-11-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/10/22/5434 |
| _version_ | 1797509840953671680 |
|---|---|
| author | Amaya Jimeno-Almazán Jesús G. Pallarés Ángel Buendía-Romero Alejandro Martínez-Cava Javier Courel-Ibáñez |
| author_facet | Amaya Jimeno-Almazán Jesús G. Pallarés Ángel Buendía-Romero Alejandro Martínez-Cava Javier Courel-Ibáñez |
| author_sort | Amaya Jimeno-Almazán |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-10T05:23:26Z |
| format | Article |
| id | doaj.art-2f5f90ffdf6e4f918952896f2389012e |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T05:23:26Z |
| publishDate | 2021-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-2f5f90ffdf6e4f918952896f2389012e2023-11-22T23:51:22ZengMDPI AGJournal of Clinical Medicine2077-03832021-11-011022543410.3390/jcm10225434Chronotropic Incompetence in Non-Hospitalized Patients with Post-COVID-19 SyndromeAmaya Jimeno-Almazán0Jesús G. Pallarés1Ángel Buendía-Romero2Alejandro Martínez-Cava3Javier Courel-Ibáñez4Department of Infectious Diseases, Hospital Universitario Santa Lucía, Cartagena, 30202 Murcia, SpainHuman Performance & Sport Sciences Laboratory, University of Murcia, 30720 Murcia, SpainHuman Performance & Sport Sciences Laboratory, University of Murcia, 30720 Murcia, SpainHuman Performance & Sport Sciences Laboratory, University of Murcia, 30720 Murcia, SpainHuman Performance & Sport Sciences Laboratory, University of Murcia, 30720 Murcia, SpainPatients 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.https://www.mdpi.com/2077-0383/10/22/5434post-COVID-19 conditionlong COVID-19long-haulerschronic fatiguepost-exertional malaiseautonomic nervous system |
| spellingShingle | Amaya Jimeno-Almazán Jesús G. Pallarés Ángel Buendía-Romero Alejandro Martínez-Cava Javier Courel-Ibáñez Chronotropic Incompetence in Non-Hospitalized Patients with Post-COVID-19 Syndrome Journal of Clinical Medicine post-COVID-19 condition long COVID-19 long-haulers chronic fatigue post-exertional malaise autonomic nervous system |
| title | Chronotropic Incompetence in Non-Hospitalized Patients with Post-COVID-19 Syndrome |
| title_full | Chronotropic Incompetence in Non-Hospitalized Patients with Post-COVID-19 Syndrome |
| title_fullStr | Chronotropic Incompetence in Non-Hospitalized Patients with Post-COVID-19 Syndrome |
| title_full_unstemmed | Chronotropic Incompetence in Non-Hospitalized Patients with Post-COVID-19 Syndrome |
| title_short | Chronotropic Incompetence in Non-Hospitalized Patients with Post-COVID-19 Syndrome |
| title_sort | chronotropic incompetence in non hospitalized patients with post covid 19 syndrome |
| topic | post-COVID-19 condition long COVID-19 long-haulers chronic fatigue post-exertional malaise autonomic nervous system |
| url | https://www.mdpi.com/2077-0383/10/22/5434 |
| work_keys_str_mv | AT amayajimenoalmazan chronotropicincompetenceinnonhospitalizedpatientswithpostcovid19syndrome AT jesusgpallares chronotropicincompetenceinnonhospitalizedpatientswithpostcovid19syndrome AT angelbuendiaromero chronotropicincompetenceinnonhospitalizedpatientswithpostcovid19syndrome AT alejandromartinezcava chronotropicincompetenceinnonhospitalizedpatientswithpostcovid19syndrome AT javiercourelibanez chronotropicincompetenceinnonhospitalizedpatientswithpostcovid19syndrome |