Although its exact prevalence has not yet been established, several post-COVID case reports reveal the presence of dysautonomia; that is, a dysfunction of the autonomic nervous system characterized by orthostatic intolerance (discomfort or dizziness when moving to a standing position after sitting or lying down) or postural tachycardia syndrome (POTS), an abnormally high increase in the heart rate. Many individuals also report symptoms such as dizziness, post-exertional malaise, palpitations, digestive problems (such as nausea, diarrhea or abdominal pain), bladder incontinence or vision problems.
These symptoms may be related to dysautonomia.
Dysautonomia could explain the post-exertional malaise that patients might identify as extreme fatigue or exhaustion.
How do we test for it ?
It is advisable to undergo an orthostatic assessment at your doctor’s office. You can talk to your primary care physician about this (your blood pressure and heart rate will be measured for 10 minutes while lying down and standing up).
If the results of the physical examination and the basic tests are normal but there is still a strong suspicion that the patient may be suffering from dysautonomia, particularly if he or she experiences post-exertional malaise (an inability to recover after exerting oneself, even after minimal effort), other cardiological or neuropsychological tests, such as a tilt test, can be performed.. In some cases, a Holter monitor can be used for 24–48 hours to detect changes in the heart rate at night or during the day.
How is it treated ?
Dysautonomia is difficult to treat and can have a significant impact on the individual’s quality of life.
You should first try non-pharmaceutical treatments that focus on prevention and preserving energy levels, with regular check-ups.
Tips:
- Try not to get up quickly.
- Sleep in a semi-reclined position.
- Wear custom-made support stockings.
- Ensure your salt intake is between 6 and 10 grams a day
- Stay well hydrated (drink 2–3 litres a day)
- Drink water before meals
- Have small, regular meals
- Lie down after heavy meals
Medication is available as a second line of treatment, in addition to the non-pharmaceutical interventions. Medication is prescribed only in documented cases of dysautonomia, in consultation with a cardiologist or a neurologist.
