Some COVID Long Haulers Are Being Diagnosed With POTS

Woman wearing a face mask in a bed.

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Key Takeaways

  • Reports show that long COVID may be linked with an autonomic disorder called postural orthostatic tachycardia syndrome (POTS).
  • Experts speculate that COVID-19 antibodies may be targeting the autonomic nervous system, which can cause POTS after an infection.
  • Studies examining long COVID may hopefully help researchers further understand POTS.

Many of the lingering complications some people experience after a COVID-19 infection—like fatigue and shortness of breath—seem like remnants of their initial illness. But new reports show these symptoms may be connected to a condition still poorly understood: postural orthostatic tachycardia syndrome (POTS).

POTS is an autonomic disorder, which means it affects the branch of the nervous system that regulates blood pressure, heart rate, and body temperature.

In September, California recorded the first case of POTS following a SARS-CoV-2, the virus that causes COVID-19, infection. Later on, more cases began appearing, not just in the United States but in other countries as well.

Data on the link between the two is still in its early stages. There aren’t any large studies looking at the rates of POTS in COVID-19 patients, so much remains to be understood about the connection.

What Is POTS?

“POTS is a syndrome characterized by a fairly dramatic increase in heart rate upon standing,” F. Perry Wilson, MD, MSCE, a physician at Yale Medicine and researcher at the Yale School of Medicine, tells Verywell. “In other words, when a patient with POTS stands up—from lying down or sitting—their heart starts to race.”

Some symptoms of POTS can include:

  • Shortness of breath
  • Headache
  • Fatigue
  • Poor concentration
  • Heart palpitations
  • Weakness
  • Anxiety

The signs are similar to that of long COVID, but with POTS, light-headedness and other symptoms ease up if the individual lies back down. Overall, the disorder can significantly affect a person's quality of life.

“POTS patients may have difficulty standing in line at the grocery store, or brushing their teeth, or cooking in the kitchen,” Wilson says.

POTS can affect people of all ages, but most cases occur in women between 15 and 50 years old.

“Autoimmune diseases are more prevalent in women and given that POTS is thought to have an autoimmune substrate, it may be why we see more cases in women,” Pam R. Taub, MD, FACC, director of the Step Family Foundation Cardiovascular Rehabilitation and Wellness Center and associate professor of medicine at the UC San Diego School of Medicine, tells Verywell.

There isn’t enough data to say for sure, but the female to male predominance will likely hold in post-COVID-19 cases of POTS, according to Wilson.

How Are POTS and COVID-19 Linked?

Scientists are still unsure what causes POTS. While there are many hypotheses, there’s no single driver behind the condition. According to the National Institutes of Health (NIH), major surgery, trauma, pregnancy, or viral illness can jump-start these episodes.

“A leading hypothesis is that there is an autoimmune component to POTS as some cases occur after a viral infection,” Taub says. “It is thought the antibodies produced against a viral infection in some individuals also attack the body’s autonomic nervous system, which is responsible for regulating heart rate and blood pressure.”

According to Wilson, its link to viral illnesses may be due to cross-reactive antibodies where the “body mounts a defense against a virus and those same antibodies inadvertently target your own cells.” This connection might explain why some COVID long-haulers are developing the disorder. 

“POTS frequently comes after a period of prolonged deconditioning—particularly bed rest—which a lot of patients with bad COVID-19 cases have gone through,” Wilson says. “We do worry about cross-reactive antibodies, but so far, I haven't seen data confirming those antibodies are present in patients with POTS post-COVID. That work will need to be done.”

What This Means For You

If you currently experience post-acute sequelae of SARS-CoV-2 (PASC) or "long COVID" and you recognize symptoms of POTS, it is worth getting checked out by your primary care provider. POTS can affect your daily routines, but receiving treatment may reduce its symptoms.

What Does POTS Diagnosis and Treatment Look Like?

POTS is often diagnosed based on symptoms as they arise, but there is usually a delay in diagnosis because they encompass multiple organ systems, Taub says. In some cases, it may be mistaken for other health conditions like orthostatic hypotension or misinterpreted as a psychiatric illness.

“The diagnosis can be made in the office by documenting an increase in heart rate of greater than or equal to 30 bpm when moving from a recumbent to an upright posture within 10 minutes of standing,” Taub says. “In many cases, patients don’t meet the black and white definition and may not have a clear 30 point increase, and these patients may still have POTS.”

Patients need to be continually evaluated if there is a suspicion of POTS.

Varied Treatments

Since there are plenty of causes of POTS, there are a variety of potential treatments as well. There’s no single recommended treatment that works for every scenario.

“The mainstay of therapy is to increase water and salt intake—provided blood pressure isn't too high—and to do reconditioning physical therapy, [such as] aerobic exercise and leg strength training,” Wilson says. “The latter is tough for these patients, since it tends to bring out the symptoms, but it really is important.”

It’s possible for patients to recover completely, but for many, symptoms will never fully go away.

“We typically expect about 20% to resolve completely within a year, 20% to not get better, and the remaining 60% to get substantially better but to have some residual symptoms,” Wilson says. “I think the key thing is to remember that re-conditioning is really key. I mention that because it is hard—when you have POTS it's much more comfortable to be reclining—but we need to help patients face the discomfort of exercise therapy in service of their long-term chances for improvement.”

The emergence of post-COVID-19 cases of POTS brought more attention to the poorly understood health condition. According to a statement from the American Autonomic Society, this may be a window of opportunity to understand the condition further. However, addressing the link between COVID-19 and POTS will require plenty of resources and funding for clinical care and research.

“It is an area where our understanding is in its primitive stages and we need to conduct rigorous scientific research to better characterize the disease,” Taub says. “It is also an area where there is a critical unmet need for therapies.”

Last December, the NIH received $1.15 billion in funding to research the long-term effects of COVID-19. In February, they officially launched an initiative to study long COVID and the reason behind prolonged symptoms. The NIH also hopes to understand other chronic post-viral syndromes and autoimmune diseases, which will likely touch on POTS.

“This can be a debilitating condition that has a severe impact on quality of life,” Wilson says. “It deserves more attention.”

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Johansson M, Ståhlberg M, Runold M, et al. Long-haul post–COVID-19 symptoms presenting as a variant of postural orthostatic tachycardia syndrome: the Swedish experience. JACC: Case Reports. 2021;3(4):573-580. doi:10.1016/j.jaccas.2021.01.009

  3. National Institutes of Health. Postural orthostatic tachycardia syndrome.

  4. Centers for Disease Control and Prevention. Post-COVID conditions.

  5. Raj SR, Arnold AC, Barboi A, et al. Long-COVID postural tachycardia syndrome: an American Autonomic Society statement. Clin Auton Res. 2021;31(3):365-368. doi:10.1007/s10286-021-00798-2

  6. National Institutes of Health. NIH launches new initiative to study “Long COVID.”

By Carla Delgado
Carla M. Delgado is a health and culture writer based in the Philippines.