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.

POTS has been associated with COVID-19. Some people who have long COVID have reported experiencing a racing heart and other symptoms consistent with POTS.

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.

What is long COVID-19?

Long COVID refers to long-term health problems that can affect people who’ve had COVID-19. The Centers for Disease Control and Prevention (CDC) notes that it can affect anyone who’s had COVID-19, regardless of illness severity.

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Many long COVID symptoms overlap with those of POTS. These can include heart palpitations, dizziness, and brain fog.

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.

A 2022 review notes that an estimated 2% to 14% of people who’ve had COVID-19 may experience POTS in the months after their illness. A larger number of people, 9% to 61%, may have POTS-like symptoms that usually occur when moving to an upright position. POTS-like symptoms include:

  • racing heart
  • dizziness
  • blurred vision
  • fatigue
  • chest discomfort
  • cognitive impairment

A small 2021 case study found that the people who developed POTS after COVID-19 had no prior history of orthostatic symptoms. Orthostatic means “relating to an upright posture.”

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:

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.

Heart palpitationsXX
Shortness of breathXX
Chest painXX
Upset stomachX
Brain fogXX
Pins-and-needles sensationsX
Altered smell or tasteX
Fatigue or weaknessXX
Shaking and sweatingX
Muscle or joint painX
Skin rashX
Menstrual changesX
Trouble sleepingXX
Depression or anxietyX

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

POTS is most common in women between the ages of 15 and 50. Indeed, in many of the case series of post-COVID POTS, individuals are younger in age and predominantly female.

It’s also possible for POTS to develop after a traumatic event. These can include illness, injury, or surgery.

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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

Case series of people with post-COVID POTS detail that the condition was treated using at-home management as well as medications like beta-blockers, ivabradine, and midodrine.

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 2021 case series followed 20 people with post-COVID POTS and similar disorders. None of these individuals had been hospitalized while they were ill with COVID-19.

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?

Some case reports and case series have reported POTS after the mRNA COVID-19 vaccines. However, these reports are very rare, and additional research is needed.

The COVID-19 vaccines remain a safe and effective way to prevent serious illness and death due to COVID-19.

Can other infections trigger POTS?

Yes. Some examples of other infections that have been associated with POTS include mononucleosis, the flu, and Lyme disease.

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 here.

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.