Possible Role of Fibrinaloid Microclots in Postural Orthostatic Tachycardia Syndrome (POTS): Focus on Long COVID
Abstract
:1. Introduction
Orthostasis, Orthostatic Intolerance, and POTS
2. The Normal Control of Heart Rate
3. Diagnosis of POTS
4. Occurrence and Comorbidities of POTS
5. Dysautonomia
6. Fatigue and POTS
7. The Role of Fibrinaloid Microclots in POTS
- Relative hypovolemia secondary to inadequate peripheral vasoconstriction. This results in a reduction in stroke volume and cardiac output, causing the inhibition of tissue oxygen supply and the consequent compensatory tachycardia.
- Small fiber neuropathy (SFN) has been well described in long COVID (e.g., [63,65,68,172]) and is a recognized cause of dysautonomia in the condition. SFN in long COVID can be driven by autoantibodies (already known to be associated with POTS and OH) or, potentially, by ischemia of the small fibres due to microclots.
8. The Role of Microclots in Fatigue
9. Relationship between Dysautonomia and Microclots
10. Systems Overview and Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Disease, State, or Syndrome | Comments | Selected Reference(s) |
---|---|---|
Autoimmune disorders and Autoimmunity | Some strong associations | [16,22,23,24,25,26] |
Cognitive function | Large amount of literature; improved by plasma exchange [27] | [27,28,29,30] |
Fatigue | [31,32,33,34,35,36,37,38] | |
HPV or other antiviral vaccination | An example of induction by a viral protein | [39,40,41,42,43,44,45] but cf. [46] |
Inflammation | [47] | |
Irritable bowel disease | [48] | |
Long COVID | A very common occurrence and a focus of our interest | [16,17,18,19,20,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68] |
Migraine | [69] | |
Multiple sclerosis | Now recognized as possibly caused by Epstein–Barr virus [70] (albeit much earlier evidence for an infectious origin existed [71,72], cf. [73,74]). | [75] |
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) | Is also usually a postviral disease and bears a number of similarities to long COVID [68,76,77,78,79] | [31,32,52,80,81,82,83,84] |
Platelet delta granule storage pool deficiency | Causal direction unclear | [85] |
Pregnancy | Many cardiovascular stresses accompany pregnancy, especially during hypertensive disorders [86,87] | [88,89] |
Reviews | [22] |
Disease, State, or Syndrome | Comments | Selected Reference(s) |
---|---|---|
Familial (monogenic) | Lesion in the IKBKAP gene | [118] |
Long COVID | [57,60,62,63,67,76,119,120,121,122,123,124] | |
Multiple sclerosis | [125,126] | |
Myalgic encephalomyelitis/chronic fatigue syndrome | [76,82,119,127,128,129,130,131,132,133] | |
Parkinson’s disease | [134] |
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Kell, D.B.; Khan, M.A.; Kane, B.; Lip, G.Y.H.; Pretorius, E. Possible Role of Fibrinaloid Microclots in Postural Orthostatic Tachycardia Syndrome (POTS): Focus on Long COVID. J. Pers. Med. 2024, 14, 170. https://doi.org/10.3390/jpm14020170
Kell DB, Khan MA, Kane B, Lip GYH, Pretorius E. Possible Role of Fibrinaloid Microclots in Postural Orthostatic Tachycardia Syndrome (POTS): Focus on Long COVID. Journal of Personalized Medicine. 2024; 14(2):170. https://doi.org/10.3390/jpm14020170
Chicago/Turabian StyleKell, Douglas B., Muhammed Asad Khan, Binita Kane, Gregory Y. H. Lip, and Etheresia Pretorius. 2024. "Possible Role of Fibrinaloid Microclots in Postural Orthostatic Tachycardia Syndrome (POTS): Focus on Long COVID" Journal of Personalized Medicine 14, no. 2: 170. https://doi.org/10.3390/jpm14020170