There is some evidence that the coronavirus that causes COVID-19 may also trigger a condition called postural orthostatic tachycardia syndrome (POTS) in people with long-haul COVID-19 (people who have recovered from the initial illness but still have lingering symptoms).
What Is POTS?
POTS is a debilitating condition that causes your heart to speed up by at least 30 beats per minute after you move from sitting or lying down to standing. This happens when your body’s autonomic nervous system, which should work automatically, fails to control your blood pressure and heart rate to make up for your change in posture.
It doesn’t always happen immediately. It can sometimes take as long as 10 minutes after you stand. You may get dizzy and even faint.
POTS isn’t well-known. Many people with the condition report that it took them quite a while to get a diagnosis.
How Is POTS Linked to COVID-19?
POTS can be triggered by a number of things like infection or surgery. But viruses or bacteria seem to trigger it most often, and some scientists think the coronavirus might be among them. That’s because some people who recovered from COVID-19 seem to have POTS-like symptoms like:
- A faster heart rate with slight increase in activity
- Trouble thinking (brain fog)
- Lightheadedness
- Headaches
- Nausea and vomiting
- Extreme tiredness that won’t go away (severe chronic fatigue)
Who Gets Post-COVID POTS?
It appears that anyone who has had COVID-19 can get POTS, whether the virus initially caused serious symptoms or mild ones. But there are some things that seem to raise your risk for post-COVID POTS, though scientists aren’t yet sure about them. These include a pre-COVID history of:
- Concussion
- Dizziness
- Lightheadedness or passing out
- Racing or skipping heart (palpitations)
A faulty immune system that mistakenly attacks your body’s tissues (autoimmune response) also seems to play a part in POTS.
People with POTS tend to have higher rates of autoimmune markers like those from thyroid disease, rheumatoid arthritis, and celiac disease. They also have signs of inflammation, including in the heart. COVID-19 may also be a cause of this autoimmune response, though more study is needed.
What Can You Do?
In the short-term, if you feel lightheaded or dizzy, sit or lie down right away. When you feel well enough to get up, do it slowly and carefully to give your body a chance to adjust. Ask for help if you need it.
Talk to your doctor if you notice any of the above symptoms. Be sure to tell your doctor if you’ve had (or suspect you’ve had) COVID-19.
How Do Doctors Diagnose Post-COVID POTS?
Doctors don’t yet know all the possible effects of long-haul COVID-19. That’s why, to make a diagnosis, your health care team will first try to rule out other causes of your symptoms. For example, COVID-19 can cause blood clots or scars in your lungs. These can cause symptoms similar to POTS but need different treatments.
Once your doctor rules out other conditions, they will likely refer you to a specialist who can diagnose POTS.
How Do Doctors Treat Post-COVID POTS?
Treatment will depend on the nature of your symptoms, age, and general health. Your health care team may suggest that you:
- Drink plenty of water
- Get more salt in your diet
- Use compression stockings to keep fluid from pooling in your legs
In addition, your doctor could prescribe different medications to fit your symptoms like:
- Beta-blockers or calcium channel blockers to lower heart rate
- Fludrocortisone or midodrine to help with blood pressure
- SSRIs and SNRIs
- Anxiety medications
- Supplemental vitamins
- Medications (including some over-the-counter) for headache or nerve pain
Some research is looking at immunotherapy as a treatment.