Autonomic Aftershock; A Case of Post-Covid Dysautonomia

Resha Reya Ganthan MD^1, , Fadi Yacoub MD², Asher Gorantla MD² and Nidal Isber MD FACC FHRS^{3, 4}

¹Department of Internal Medicine, Richmond University Medical Center/Mount Sinai, Staten Island, NY, USA

²Department of Cardiology, State University of New York Downstate, Brooklyn, NY, USA

³Department of Cardiology, Richmond University Medical Center/Mount Sinai, Staten Island, NY, USA

⁴Department of Electrophysiology, Richmond University Medical Center/Mount Sinai, Staten Island, NY, USA

Cite this paper:
Resha Reya Ganthan MD, Fadi Yacoub MD, Asher Gorantla MD and Nidal Isber MD FACC FHRS. Autonomic Aftershock; A Case of Post-Covid Dysautonomia. American Journal of Medical Case Reports. 2025; 13(7):41-45. doi: 10.12691/ajmcr-13-7-2

Abstract

The long-term effects following a COVID-19 infection vary widely, with that including inappropriate sinus tachycardia as a manifestation. Herein we report the case of a middle-aged woman with a history significant for a COVID-19 infection 2-years prior, following which she developed brief episodes of palpitations, otherwise controlled with Metoprolol Succinate. She presented to the hospital after a 1-week history of worsening palpitations far worse in severity from prior episodes, associated with shortness of breath and pre-syncope. ECG on admission demonstrated sinus tachycardia with a significantly elevated heart rate. Multiple repeat ECGs demonstrated periods of sinus tachycardia when symptomatic alternating with a normal sinus rhythm when asymptomatic. Continuous telemetry monitoring while inpatient reported similar findings, with no other tachyarrhythmias present. Multiple other diagnostic tests were performed to rule out a more malignant cause of autonomic instability, which ultimately yielded negative results. The patient was however additionally diagnosed with orthostatic hypotension, which posed a potential confounding factor in the steadfast diagnosis of inappropriate sinus tachycardia. This case highlights the multiple simultaneous manifestations of post-covid syndrome with significant symptom overlap, leading to a missed diagnosis.

Keywords:
Inappropriate sinus tachycardia (IST) Intrinsic heart rate (IHR) Electrocardigram (EKG) Orthostatic hypotension Post-Covid syndrome (PCS) Postural orthostatic tachycardia syndrome (POTS) Sinoatrial node (SAN) Transthoracic echocardiography (TTE) Tilt-table test (TTT)

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