Symptoms of POTS, such as heart palpitations, dizziness, and brain fog that occur when moving to an upright position, have been associated with COVID-19, particularly long COVID.
Postural orthostatic tachycardia syndrome (POTS) is a rapid heart rate that happens when you sit or stand up.
This article takes a look at the connection between POTS and COVID-19, along with the symptoms, causes, and treatment of POTS. Keep reading to learn more.
Throughout the COVID-19 pandemic, a number of cases describe adults who have developed POTS after having COVID-19. Post-COVID POTS has also been reported in children.
- racing heart
- blurred vision
- chest discomfort
- cognitive impairment
POTS happens when your heart rate increases by at least 30 beats per minute within 5 to 10 minutes of moving to an upright posture. This can lead to symptoms such as:
- heart palpitations
- shortness of breath
- chest pain
- brain fog
- fatigue or weakness
- shaking and sweating
- trouble sleeping
People diagnosed with POTS have been experiencing their symptoms for 6 months or more. They also have no evidence of orthostatic hypotension. This is when blood pressure drops after moving to an upright position.
It’s worth noting that there’s a significant overlap between POTS symptoms and long COVID symptoms. The table below helps to illustrate this.
|Shortness of breath
|Altered smell or taste
|Fatigue or weakness
|Shaking and sweating
|Muscle or joint pain
|Depression or anxiety
When you move to an upright position, gravity causes blood to travel to your lower body. In order to counteract this, your brain tells blood vessels to constrict and your heart rate to rise. This allows the upper part of your body to get enough blood.
In people with POTS, this response doesn’t proceed as is typical. This leads to the pooling of blood in the lower body when you sit or stand up, which causes your heart to beat rapidly in order to compensate.
It’s unclear what exactly causes POTS to occur. However, experts have outlined several different mechanisms that may contribute to POTS alone or in combination:
- Nerve damage: Nerve damage in your lower limbs affects the constriction of blood vessels in this area, meaning they don’t constrict in response to posture changes.
- Hormones: Higher levels of the hormone norepinephrine, which is associated with higher heart rate and blood pressure, are present during a POTS episode.
- Blood volume: People with POTS have an overall lower blood volume than is typical, magnifying the effects of moving to an upright position.
- Autoimmune disorder: Autoimmune activity, which is when the immune system attacks healthy tissues, contributes to POTS.
How does COVID-19 cause POTS?
While more research is necessary, it’s believed that COVID-19 may contribute to POTS in a few different ways.
One idea is that fever and sweating associated with COVID-19 decreases blood volume. Additionally, long periods of bed rest while you’re ill may decondition the heart. Basically, this means that it’s more out of shape.
Another idea has to do with SAR-CoV-2, the virus that causes COVID-19, directly infecting parts of the nervous system. This could lead to nerve damage that may contribute to POTS.
Finally, post-COVID POTS may result from activity of the immune system. This could include damage from excess inflammation as your body fights the infection.
Risk factors for POTS
Sometimes, POTS can be managed at home by doing the following:
- moving slowly into an upright position
- avoiding standing for long periods of time
- lying down and raising your legs if you’re experiencing a POTS episode
- drinking plenty of water to stay hydrated
- getting regular exercise, as physical activity promotes a healthy heart and strong leg muscles help to push blood back toward the heart
- increasing salt intake under the supervision of your doctor
- reducing the consumption of alcohol and caffeine
- wearing compression clothing to help improve blood flow in your legs
If the above strategies aren’t effective at improving your symptoms, a doctor may suggest trying a medication. These may include:
- beta-blockers, such as propranolol or metoprolol, which decrease heart rate
- ivabradine, which also lowers heart rate
- midodrine, which works by constricting blood vessels
- fludrocortisone, which helps to increase blood volume by reducing the salt lost in your urine
Some people with POTS have mild symptoms. However, others find that it has a large impact on their quality of life. In many situations, POTS slowly improves as time passes.
When it comes to post-COVID POTS, we’re still learning more. The findings from some of the case series suggest that treating the condition can be challenging.
For example, a
Six to eight months after COVID-19, 17 people (85%) still reported some lingering symptoms. However, many felt as if their symptoms had improved with treatment, which included at-home care, medications, or both.
Post-COVID POTS continued to have a large impact on the daily life of many individuals in the study. Only eight people (40%) were able to return to work full- or part-time, while the rest were still unable to return to work.
Can the COVID-19 vaccine cause POTS?
Can other infections trigger POTS?
If you already have POTS, are you at a greater risk of a more serious COVID-19 infection?
It’s still unclear. However, it’s important to note that viral infections like COVID-19 can temporarily worsen many health conditions. The CDC lists the medical conditions that are confirmed to be associated with more serious COVID-19
Is POTS a fatal illness?
No. However, POTS can have a large impact on the quality of life for some people. Additionally, it’s possible to faint during a POTS episode, which can increase the risk of injury from falling down.
How is POTS diagnosed?
To diagnose POTS, a doctor will first need to rule out other health conditions, particularly those affecting the heart. In addition to blood tests to assess overall health, this can include heart diagnostics such as:
If POTS is suspected, tests can be done to assess how heart rate and blood pressure change when you move into an upright position. This includes the tilt-table test and the active stand test.
How common is POTS?
Prior to the COVID-19 pandemic, POTS was estimated to affect about 500,000 people in the United States.
POTS is a condition that causes your heart rate to increase when you move into an upright position. It’s been associated with long COVID.
It’s unclear how exactly COVID-19 can lead to POTS. However, it could be due to the physical effects of the illness, tissue damage from the infection, or autoimmune factors, or a combination of these.
POTS can be treated with at-home strategies and, if necessary, medications. Current research shows that it’s still possible to have lingering POTS symptoms several months after COVID-19.
If you have persistent symptoms after being ill with COVID-19, make an appointment with a doctor. They can evaluate your symptoms and develop a plan to help manage them.