Autonomic nervous system involvement in COVID 19 and risk of sudden cardiac death

The acute SARS CoV 2 infection causes increased metabolic demand with reduced cardiac reserve, tachypnoea, acidosis, hypoxia causing deleterious effects on cardiac myocytes. Since its heightened sympathetic state these patients are more prone for malignant arrhythmias. The central nervous system involvement of MERS-CoV is mostly caused by the autoimmune reaction against viral antigens rather than viral infection itself. Although coronaviruses can infect the autonomic center in the brainstem, potentially contributing to cardiovascular and respiratory failure, the direct effect of SARS-CoV2 on the autonomic nervous system is not well known yet. The purpose of this review is to emphasise the involvement of autonomic nervous system (ANS) which is an integral part of our human body to adapt for the stressful environment like COVID 19 infection.