Thread by @SalvMattera

My worst long COVID symptoms have been heart-related. I've seen a cardiologist off and on, but also sought a second opinion from an expert. He sent me this note that included a lengthy list of tests he recommended. Maybe someone here will find it useful:

"You need a cardiac monitor to see if you are having any arrhythmias. I would also have you perform a treadmill ECG stress test to see if it can reproduce your chest pain and see if your ECG shows any changes."

"a tilt table test is often used, but the way it is done at most centers relies on blood pressures taken every minute or every few minutes. This may pick up severe cases, but a lot can happen with blood pressure within a minute that might correlate with your symptoms."

"A type of tilt table study that measures your blood pressure non-invasively on a beat-to-beat basis is helpful."

Initial tests: "echocardiogram, EKG, Holter monitor, autonomic reflex screen, complete blood cell count (CBC), thyroid panel, morning cortisol level, plasma and urine metanephrines, vitamin B12 level, celiac testing, antinuclear antibody (ANA) screen"

More initial tests: "Sjögren antibody (SSA/SSB) screen, supine and standing norepinephrine levels, serum tryptase (or urine tryptase), adenosine level, etc.""

Secondary tests: "voltage gated potassium channel antibody complexes, N-type calcium channel antibody, ganglionic acetylcholine receptor antibodies, P/Q type calcium channel antibodies, alpha 1 adrenergic receptor autoantibodies (failure of peripheral vasoconstriction)"

If those don't show anything, move to secondary tests: "voltage gated potassium channel antibody complexes, N-type calcium channel antibody, ganglionic acetylcholine receptor antibodies, P/Q type calcium channel antibodies"

More secondary tests: "alpha 1 adrenergic receptor autoantibodies (failure of peripheral vasoconstriction), beta 1 adrenergic receptor autoantibodies (accentuation of compensatory tachycardia)"

Last set of tests: "beta 2 adrenergic receptor autoantibodies (accentuation of compensatory tachycardia), and CPET (cardiopulmonary exercise testing) to evaluate degree of deconditioning if needed, but in your case this may be challenging to perform."

FWIW, he also told me that he believes many people get better over time without treatment. But that long COVID is more likely when people have had multiple COVID infections.

Which was another reason why I started writing and tweeting about this back in July: Given enough reinfections, maybe everyone will eventually develop some form of long COVID. Seems like it's only a matter of time.