The COVID-19 pandemic has highlighted the emergence of chronic health conditions following infection. A key concern is the development of Postural Orthostatic Tachycardia Syndrome (POTS) in individuals who have recovered from COVID-19. This article explores the established link between COVID-19 and POTS, and how the virus might contribute to this complex condition.
Understanding Postural Orthostatic Tachycardia Syndrome
Postural Orthostatic Tachycardia Syndrome (POTS) is a disorder of the autonomic nervous system, which controls involuntary bodily functions like heart rate, blood pressure, and digestion. Individuals with POTS experience an abnormal, sustained increase in heart rate when standing, typically 30 beats per minute (bpm) or more within 10 minutes, without a significant drop in blood pressure.
Symptoms frequently reported by those with POTS include dizziness, lightheadedness, fatigue, brain fog, and heart palpitations. These symptoms usually improve when the individual lies down, highlighting the condition’s postural nature. POTS is classified as a form of dysautonomia, a broader term for autonomic nervous system dysfunction.
The Connection Between COVID-19 and POTS
Evidence indicates a link between COVID-19 infection and the development of POTS. Many individuals report POTS-like symptoms after recovering from COVID-19, often as part of “Long COVID” or Post-Acute Sequelae of SARS-CoV-2 infection (PASC). Research suggests a significant percentage of COVID-19 survivors develop POTS within 6 to 8 months following infection.
Studies indicate an increased incidence of POTS after COVID-19; some research finds people who had COVID-19 were five times more likely to develop POTS compared to vaccinated individuals who contracted the virus. This connection has been observed in individuals with both mild and severe COVID-19, suggesting initial disease severity does not predict the risk of post-COVID POTS. The symptom similarity between Long COVID and POTS often prompts testing for POTS in patients with lingering post-viral symptoms.
How COVID-19 Might Lead to POTS
The exact biological mechanisms by which COVID-19 triggers POTS are still being investigated. One prominent theory involves an autoimmune response, where the immune system, after fighting the virus, mistakenly produces autoantibodies that attack healthy tissues, including components of the autonomic nervous system. These autoantibodies might target receptors involved in regulating blood vessel constriction and heart rate, leading to the dysregulation seen in POTS.
Another proposed mechanism is viral persistence, where the SARS-CoV-2 virus or its remnants remain in the body, causing ongoing inflammation or direct damage to nerve cells or blood vessels. This damage can occur as the virus’s spike protein binds to ACE2 receptors in various organs, including brain areas that regulate autonomic functions. Chronic inflammation, often called cytokine hyperactivation, is also thought to contribute to autonomic nervous system dysregulation and POTS symptoms. The virus may also directly affect the brainstem, which regulates cardiovascular and autonomic functions.
COVID-19 infection can also lead to hypovolemia, or low blood volume, which, combined with deconditioning from inactivity, can contribute to POTS. Additionally, impaired regulation of blood flow due to changes in blood vessel function may play a role, as blood vessels in individuals with POTS may not constrict efficiently.
Recognizing and Addressing Post-COVID POTS
Individuals suspecting post-COVID POTS should be aware of specific symptoms. These typically worsen with prolonged standing, exercise, or in warm environments.
- Sustained increase in heart rate upon standing
- Lightheadedness
- Dizziness
- Profound fatigue that does not improve with rest
- Cognitive difficulties (“brain fog”)
- Headaches
- Nausea
- Chest pain
- Shortness of breath
If persistent or worsening symptoms occur after a COVID-19 infection, seek medical attention. A doctor can help rule out other conditions that might cause similar symptoms, such as blood clots or heart failure. Diagnosis of POTS typically involves a tilt-table test or a standing test, monitoring heart rate and blood pressure while transitioning from lying to standing. A significant heart rate increase without a substantial blood pressure drop can indicate POTS.
Management strategies for post-COVID POTS often involve non-pharmacological approaches.
- Increasing fluid and salt intake (2-3 liters of fluid and up to 10 grams of salt per day, unless medically contraindicated)
- Wearing compression garments, particularly waist-high compression stockings with 20-30 mmHg pressure, to reduce blood pooling in the lower extremities
- Careful, graded exercise
- Lifestyle adjustments
- Optimizing sleep