COVID-19 is getting on our nerves: Sympathetic neural activity and hemodynamics in young adults recovering from SARS-CoV-2.

KEY POINTS: The impact of SARS-CoV-2 infection on autonomic and cardiovascular function in otherwise healthy individuals is unknown. We show for the first time that young adults recovering from SARS-CoV-2 have elevated resting sympathetic activity, but similar heart rate and blood pressure, compared with control subjects. Survivors of SARS-CoV-2 also exhibit suppressed sympathetic nerve activity and pain perception during a cold pressor test compared with healthy controls. Further, these individuals display higher sympathetic nerve activity throughout an orthostatic challenge, as well as an exaggerated heart rate response to orthostasis. If similar autonomic dysregulation, like that found here in young individuals, is present in older adults following SARS-CoV-2 infection, there may be substantial adverse implications for cardiovascular health. ABSTRACT: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can elicit systemic adverse physiologic effects. However, the impact of SARS-CoV-2 on autonomic and cardiovascular function in otherwise healthy individuals remains unclear. Young adults who tested positive for SARS-CoV-2 (COV+; n = 16, 8F) visited the laboratory 35±16 days following diagnosis. Muscle sympathetic nerve activity (MSNA), systolic (SBP) and diastolic (DBP) blood pressure, and heart rate (HR) were measured in subjects at rest and during a 2-min cold pressor test (CPT) and 5 min each at 30° and 60° head-up tilt (HUT). Data were compared with age-matched healthy controls (CON; n = 14, 9F). COV+ participants (18.2±6.6 bursts·min-1 ) had higher resting MSNA burst frequency compared with CON (12.7±3.4 bursts·min-1 ) (p = 0.020), as well as higher MSNA burst incidence and total activity. Resting HR, SBP, and DBP were not different. During CPT, the change in total MSNA from baseline to peak was +71 a.u.∙min-1 in COV+ and +545 a.u.∙min-1 in CON (p = 0.008); there were no differences in HR, SBP, or DBP. COV+ subjects reported less pain during the CPT compared with CON (5.7±1.8 vs. 7.2±1.9 a.u., p = 0.036). MSNA was higher in COV+ compared with CON during HUT. There was a group-by-position interaction in MSNA burst incidence, as well as HR, in response to HUT. These results indicate resting sympathetic activity, but not HR or BP, may be elevated following SARS-CoV-2 infection. Further, cardiovascular and perceptual responses to physiological stress may be altered - including both exaggerated (orthostasis) and suppressed (pain) responses compared with healthy young adults. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.