Cardiorespiratory dysautonomia in post‐COVID‐19 condition: Manifestations, mechanisms and management

Abstract A significant proportion of COVID‐19 patients experience debilitating symptoms for months after the acute infection. According to recent estimates, approximately 1 out of 10 COVID‐19 convalescents reports persistent health issues more than 3 months after initial recovery. This ‘post‐COVID‐19 condition’ may include a large variety of symptoms from almost all domains and organs, and for some patients it may mean prolonged sick‐leave, homestay and strongly limited activities of daily life. In this narrative review, we focus on the symptoms and signs of post‐COVID‐19 condition in adults – particularly those associated with cardiovascular and respiratory systems, such as postural orthostatic tachycardia syndrome or airway disorders – and explore the evidence for chronic autonomic dysfunction as a potential underlying mechanism. The most plausible hypotheses regarding cellular and molecular mechanisms behind the wide spectrum of observed symptoms – such as lingering viruses, persistent inflammation, impairment in oxygen sensing systems and circulating antibodies directed to blood pressure regulatory components – are discussed. In addition, an overview of currently available pharmacological and non‐pharmacological treatment options is presented.