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

J Intern Med. 2023 Nov;294(5):548-562. doi: 10.1111/joim.13652. Epub 2023 May 29.


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.

Keywords: autonomous dysfunction; cardiovascular; dysautonomia; post-COVID-19 condition; pulmonary.

Publication types

  • Review

MeSH terms

  • Adult
  • Antibodies
  • Blood Pressure
  • COVID-19* / complications
  • COVID-19* / therapy
  • Humans
  • Postural Orthostatic Tachycardia Syndrome*
  • Primary Dysautonomias* / etiology
  • Primary Dysautonomias* / therapy


  • Antibodies