From the Guidelines
You likely have tachycardia after COVID-19 due to post-COVID syndrome or Long COVID, which can cause autonomic nervous system dysfunction, leading to inappropriate sinus tachycardia or postural orthostatic tachycardia syndrome (POTS) 1.
Key Considerations
- COVID-19 can trigger inflammation affecting the heart and nervous system, disrupting normal heart rate regulation 1.
- Long-term cardiovascular sequelae of COVID-19 may include chest pain, palpitations, inappropriate sinus tachycardia, postural orthostatic tachycardia syndrome, atrial arrhythmia, cardiomyopathy, and thromboembolism 1.
- A significant proportion of patients may experience long-term complications of SARS-CoV-2 infection 4 weeks from the index infection, sometimes called post-acute COVID-19 syndrome 1.
Recommended Evaluation and Management
- Consult a healthcare provider for proper evaluation, as they may recommend a beta-blocker like metoprolol (starting at 25mg twice daily) or ivabradine (5mg twice daily) to manage symptoms 1.
- Lifestyle modifications including gradual exercise reconditioning, increased fluid intake (2-3 liters daily), increased salt intake (unless contraindicated), and compression stockings may be suggested 1.
- Laboratory tests to check for anemia, thyroid dysfunction, or electrolyte abnormalities would be important to rule out other causes 1.
Important Notes
- COVID-19 can cause multi-organ damage, including cardiac impairment, which can lead to arrhythmias and other cardiovascular complications 1.
- The risk for occurrence of thromboembolic complications in the postacute COVID-19 phase is possibly associated with the duration and severity of hyperinflammatory state 1.
- Specialized evaluation by a cardiologist or autonomic specialist may be beneficial for targeted treatment, especially after persistent symptoms 1.
From the Research
Tachycardia after COVID-19 Infection
- Tachycardia, particularly sinus tachycardia, is a common electrocardiographic manifestation of COVID-19 2.
- The ECG abnormalities in COVID-19 may be due to various factors such as cytokine storm, hypoxic injury, electrolyte abnormalities, plaque rupture, coronary spasm, microthrombi, or direct endothelial or myocardial injury 2.
- Studies have shown that COVID-19 can cause cardiovascular damage, including cardiac injury and arrhythmias, which can lead to tachycardia 3, 4.
Prevalence of Tachycardia after COVID-19
- One study found that only 5.5% of patients presented with a heart rate > 100 bpm at discharge, suggesting that high heart rate at discharge is not a frequent consequence of COVID-19 3.
- However, when high heart rate does occur at discharge, it seems to be strongly related to a severe course of the disease 3.
Diagnostic and Prognostic Values of ECG
- Electrocardiography (ECG) can be a valuable diagnostic and prognostic tool for cardiac evaluation of patients with COVID-19 5.
- ECG findings such as ST-segment changes, T wave inversions, QT prolongation, and atrial fibrillation can be early indicators of cardiac involvement of COVID-19 and are associated with worse outcomes 5.
- Echocardiography can also be used to assess cardiovascular disease in patients with COVID-19, providing information on cardiac structure and function 6, 4.