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Prof Lesley Kavi - PoTS and LC Definitions Epidemiology and Case History

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Summary

This informative teaching session will explore the long term effects of Covid-19 through the lens of Autonomic Dysfunction, and provide medical professionals with the knowledge and understanding they need to properly diagnose and treat their patients. The invited guest speakers have years of experience in the field, and will discuss the latest research such as individual case reports and small case series, along with a sample case history demonstration to illustrate how to apply the information learnt. Don't miss out on this invaluable opportunity to gain new insights into Long Covid and its impact on patient care.

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Learning objectives

Learning objectives for the teaching session:

  1. Identify the three stages of Long Covid (acute, ongoing symptomatic, and post-Covid)

  2. Describe the most common symptoms of Long Covid

  3. Explain the impact of Long Covid on healthcare staff and patients in the UK

  4. Explain what autonomic dysfunction is and how it is present in Long Covid

  5. Describe the appropriate investigation and management of a patient with Long Covid and autonomic dysfunction

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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

I'd like to start by thanking all thespian hours for giving up their valuable time to date. T come and share your knowledge with everyone here. I'm guessing that their time is even more valuable now since covert started. Given their special your special interests, I'd also like to thank everyone who has come here to listen. Um, I have come to learn about called it on do parts on. I can't even begin to tell you how much your patients that value this. Well, I'm just going to screen share my slides. Uh, so my declarations are that I've been on the Long Cove, it expert panel. I'm for it. Nice on, but I received speaker payments on occasion for talk some polyps and Long Cove. It So, um, in at the end of 2000 and 20 at night, developed it's first guideline on the long term before effects of cough it 19. They collaborated with Nice with sign, which is the Scottish equivalent of Nice on a nurse with Royal College of Teepees. I think this was their first collaboration. Um, the recommendation is made by the committee where, as evidence based as what's possible at the time, Given the newness of the condition. The committee was comprised off care professionals on a number off laypeople, mostly, but not all patients on Dutilleux. The black off evidence I am at times and expert testimony was called upon on then the draft. WAAS sent Type two stakeholders for consultation. The three phases I'm described by Nice are cute Covad 19, which is up to four weeks ongoing symptomatic over it, which is from 4 to 12 weeks on Proscar over 19 syndrome, which is signs and symptoms that developed during or after uninfected, consistent with cove it 19. Bearing in mind, the testing wasn't available at the beginning and and continue for more than 12 weeks under not explained by an alternative diagnosis and these and three stages where I'm introduced for a number of reasons, partly for coding and partly for research. Um, Long Cove, it importantly, is the patient arrived term on, and that's made out of ongoing symptomatic and Post Cove it 19. So cute. Um, cough. It has an surged recently. As you can see from this graph on, in fact, almost night, 71% of the English population have no tested positive for covert since the testing was introduced and you can see that the percentages off people have tested positive and very from country to country throughout the UK and are surprisingly this'll. Graph shows the increase in people affected by Lankov it in thousands Onda as off me. Two million people in the UK were experiencing Long Cove it symptoms, and that is over 3% off the population. And remember that healthcare stuff are sometimes also patients on. But by last September, nearly two million at days have been lost in the any chest you to stuff absences, a PSA consequence of long cough it. Most common symptoms are fatigue, shortness of breath, cough and muscle ache. And although around 200 symptoms have bean documented on local, if it is more common in people is between 35 65. I'm in females in people living in deprived areas or working in and social care, education or healthcare. And it's also more common in people with other disabilities. Um, the symptoms are currently adversely affecting the day to day activities off 1.4 million people in the UK That's I'm just under strict quarters of people affected. I called it long coated, and it's also rather concerning that there seems to be an increase in lung covert and Children on's. Currently, one in 20 secondary school Children are experiencing a long cord symptoms following their most recent infection. So today, in addition to long, cold red, we're going to, um, have a focus on autonomic dysfunction, sometimes also known as dysautonomia. So I just thought I briefly discussed what that means, and the often Lamix nervous system controls the body of functions that we don't have to think about. I'm under a number of, um, including, um, but, for example, and the people function in the I breathing and got function sweating, bladder function, um, heart rate on BP control. And when the heart rate and BP controlled by the autonomic nervous system doesn't work properly, it commonly causes orthostatic intolerance. And this is the development of symptoms in the upright position that relieved by lying down on these air. Your usual sort of pre syncope symptoms, such as like headedness, nausea, sweating, palpitations and so on. On their four syndromes off orthostatic intolerance vasovagal syncope where there's a reflex drop in blood pressure and often oppose a reduction in heart rate and posts orthostatic hypertension with us a drop in blood pressure or 20/10 or more on non specific orthostatic intolerance. That's precinct recent symptoms, but we're patients on that occasion. Don't test positive for any of the preceding three syndromes. And so regarding on autonomic dysfunction in long covert, there have been a number of recent publication since the condition was recognized. These have tended to be individual case reports leading on to, and some small case Siris tend to be retrospective with relatively few numbers and no controls. Um, they're often highly selected cohort of patients, and the research is often done in a very specialized doctor. Anomic clinic setting on diagnosis off of 19 was, and generally you are often made then based on symptoms, as testing wasn't always available in the early stages on DPI, people have used different testing and procedures and different diagnostic criteria for pots in. In these studies, they're pretty much all adults studies, and there's little in the way off follow up, and this is a selection of a few off the more recent studies, and unfortunately we don't have time to date it to go into these in any detail, but just a few observations that they're mostly younger women. They've often not been hospitalized despite having quite prominent cardiac symptoms, that cardiac tests are usually normal and they have bean, um, they're treated with lifestyle measures, and then it's not uncommon for them to require medication. Um, some people notice that they've had minor autonomic symptoms before their corporate 19 infection, but perhaps didn't recognize the relevance off them at the time. Um, some studies have shown evidence of small fiber neuropathy on skin biopsy on richest, cerebral blood flow was seen in the upright position in patients with pots and patients with and long covered without pots, but not in the control group and then, generally speaking as far as it can tell now, long covert poults tends to mirror Nankov. It pops in terms of symptoms and response to treatment in Lankov. It orthostatic intelligence could be GTO, orthostatic, hypertension and less commonly on visas. Vehicle syncope know it's common, and pops is quite common on non specific orthostatic. Intolerance is probably the most common on the syndrome that seemed, and the prevalence of pots and long cold clinics is not yet fully clear. Uh, approximately fifth off Long Corbett Clinic patients have autonomic symptoms on. Certainly I've spoken to specialists from the UK from and the U. S. E. From Sweden on the roll nose, noticing a huge search in the number of professions to their clinics. Okay, and nice recommends for people who have postural symptoms. That's the symptoms of orthostatic intolerance, um, in the setting of long cold it and carry out a lying and standing BP. And for three minutes and forth, a static hypertension is suspected in 10 minutes, four pots. So just briefly want to you present a case history to you on. We've asked the speakers where it's relevant to their talk. If they could perhaps address how they would approach the management. The investigation of management off this patient. It's a 37 year old lady, and she developed symptoms in June last year. Um, she had a fever, cough, breathlessness on the loss of taste and smell. So fairly typical symptoms at the time on be tested positive for cough it 19 and you get symptoms settled after a week. Although she remained a little breathless, however, she went on to develop new, fluctuating symptoms that included fatigue and cognitive difficulties or playing folk fast palpitations during the day when she was happened about sort of crushing heavy chest pain, lightheadedness, I'm standing and a kind of allergic type rash, difficulty sleeping and putting pains in her on pins and needles in her lower arms and her lower legs and difficulty with exercise. She found that she was even struggling to climb up a flight of stairs and and any exercise was making her exhausted in her past medical history. She had mild asthma and on a salbutamol inhaler, and she'd had one cold it immunization. I'm a prior to developing her covered 19 infection and her parents. Although she was born in the UK, her parents are both originally from Pakistan. Under uncle died off a myocardial infarction, a heart attack but quite a young age on. He complained of chest pains palpitations shortly before he died, and she was she's a single mom off them two Children and and in fact, one of them developed a long term effects of coffee. 19, she was working as a nurse. In other words, in the self employed basis under income protection policy, which not not provide any payment for her for long term sick leave as they assessed, if it for work despite her GP, agreeing that she was not fit to work. Um, she was very tearful that she took three attempts to return to work, unsuccessfully doing times when she felt a little better and nursing was, you know, very important rule in her life, and this had been taken away from her. Some work colleagues were quite skeptical about her diagnosis and appear to have lost respect for her. I'm really quite resentful that she wasn't returning to work and she was feeling a burden on her elderly and parents who were having to help her with your child care on. Obviously, she had financial and concerns do to lower loss of income. So on that note, I'm going to hand back to our chairs