Narrative Review on Long COVID and the Interplay between the Cardiovascular and Autonomic Systems, with a Focus on Dysautonomia and the Management Thereof

COVID-19, caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), resulted in a global crisis in November 2019. The long-term effects of COVID-19, particularly on the heart and cardiac autonomic nervous system (ANS), are emerging as a distinct clinical phenotype and are gaining increasing recognition. Long COVID-19 symptoms may manifest as a chronic state and can have an often unpredictable, relapsing, and remitting nature. Cardio-pulmonary as well as neurologic and psychologic symptoms of long COVID-19 may cause significant morbidity. Effects on the autonomic nervous system, particularly orthostatic intolerance and syncope, are emerging as prominent features of long COVID and are less focused on. There are several approaches to supporting recovery, which encompass clinicians taking a more non-pharmacologic and holistic approach involving rehabilitation alongside psychosocial interventions and education to support self-management. A multi-disciplinary, holistic multi-faceted approach is imperative for the management of long-COVID. Ongoing clinical trials underway are needed to further delineate the effects of COVID-19 and the neurological, cardiovascular and psychological systems and the delicate interwoven interplay between the three.