Cardiovascular Autonomic Nervous System in a Patient With Hereditary Angioedema Affected by COVID-19

Abstract

Autonomic nervous system (ANS) regulation in hereditary angioedema (HAE) and coronavirus disease 2019 (COVID-19) is unknown. ANS alterations could be manifested during both the acute and post-acute phases of COVID-19. Implications of acute and chronic inflammation on ANS in HAE need to be addressed. In this case report, we monitored the systolic arterial blood pressure variability and baroreflex sensitivity in a female HAE patient both before experiencing COVID-19 symptoms and one month afterward. We also tracked the heart rate variability on the day preceding symptom onset, the day of symptom onset (SYM), the day following SYM, five days after SYM, the day of the first negative nasopharyngeal swab (i.e., 12 days after SYM), and one month after symptom onset. The results of this case report provide the characterization of vascular and cardiac autonomic profiles in an HAE patient until the resolution of an acute infection, a potential trigger for the acute HAE attack.

Keywords: baroreflex sensitivity; blood pressure variability; covid-19; heart rate variability analysis; hereditary angioedema without normal c1 inhibitor.

Figure 1. Schematic representation of the experimental set-up and assessment timeline.

Schematic representation of the experimental set-up used during head-up tilt test and multiday Holter ECG and of the assessment timeline including the day prior to the fever onset due to COVID-19 (PRE), symptom onset (SYM), the day after symptom onset (SYM1), five days after symptom onset (SYM5), 12 days after symptom onset (SYM12), and one month after symptom onset (SYM30). The red bar indicates the period of COVID-19 infection.

Figure 2. Sympathetic vascular neural modulation and baroreflex sensitivity during the head-up tilt test.

Sympathetic vascular neural modulation (panel A) and baroreflex sensitivity (panel B) were assessed the day prior to fever onset due to COVID-19 (PRE) and one month after symptom onset (SYM30) in the supine position (REST, represented by black bars) and during the head-up tilt test at 70° (TILT, represented by white bars).

Figure 3. Cardiac neural control index and vagal cardiac modulation from multiday Holter ECG.

Cardiac neural control indices (mean of the RR series (A); vagal cardiac modulation (b) estimated from the multiday Holter ECG on the day leading up to fever onset due to COVID-19 (PRE), symptom onset (SYM), the day after symptom onset (SYM1), five days after symptom onset (SYM5), 12 days after symptom onset (SYM12), and one month after symptom onset (SYM30).