Dec. 13, 2022 – A rare and debilitating heart condition known as postural orthostatic tachycardia syndrome, or POTS, was one of the first post-COVID health disorders that puzzled doctors early in the pandemic. One of the hallmark symptoms is feeling dizzy, tired, or faint while standing. Now, a new study confirms a link between POTS and COVID-19 infection. 

The study also found increased prevalence among people who got COVID-19 vaccines but hadn’t been infected. People developed POTS following infection five times more often than following vaccination, according to the study published Monday in the journal Nature Cardiovascular Research

“The main message here is that while we see a potential link between COVID-19 vaccination and POTS, preventing COVID-19 through vaccination is still the best way to reduce your risk of developing POTS,” Alan C. Kwan, MD, study author and a cardiovascular specialist at Cedars-Sinai, said in a news release.

A key sign of POTS is that after standing for 10 minutes, people with the disorder experience a rapid heartbeat increase of more than 30 beats per minute, or a heart rate of more than 120 beats per minute. Other symptoms include fainting, dizziness, fatigue, migraine, increased urination, sweaty extremities, anxiety, and tremor. 

Researchers did separate analyses to find out how often POTS occurred after vaccination and after COVID-19 infection of patients in the Cedars-Sinai Health System in California from 2020 to 2022. For the COVID-19 infection portion of the study, data for 12,460 patients who had not been vaccinated were analyzed. 

For the vaccination portion of the study, data were analyzed for 284,592 Cedars-Sinai patients of whom 57% were female and 63% were white. The average age was 52 years old. The researchers said 62% received Pfizer-BioNTech vaccines, 31% received Moderna, and 6.9% received Johnson & Johnson. 

Prior to the pandemic, POTS was a poorly understood disorder, affecting 1 to 3 million people in the U.S., usually women. It is not life threatening, although there is a dangerous risk of falling while fainting, according to Johns Hopkins Medicine. While its hallmark symptom affects heart rate, it is a nervous system disorder.

“The autonomic nervous system regulates functions we don’t consciously control, such as heart rate, blood pressure, sweating and body temperature. Malfunction in any of these areas can produce symptoms that can be shared by numerous conditions,” POTS expert Tae Chung, MD, wrote for Johns Hopkins Medicine. “Doctors who are not familiar with POTS may dismiss these symptoms as lingering effects of COVID-19 -- or even psychological symptoms. At the same time, POTS can be very debilitating and requires specific treatment, so an accurate diagnosis is vital.”

The Cedars-Sinai study authors said POTS as a result of vaccination or COVID-19 infection appeared to respond to typical treatment, such as managing hydration, taking salt tablets, exercise, and wearing compression socks. 

“In an unexpected but important way, the COVID-19 pandemic brought a great deal of awareness to POTS – both to patients and providers,” said POTS expert Peng-Sheng Chen, MD, in the news release. “Given a broader understanding of the disease, many patients can be diagnosed more quickly, permitting earlier interventions that can greatly improve their symptoms.”

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SOURCES:

Cedars Sinai: “COVID Infection, Vaccination Linked to Heart Condition.”

Nature Cardiovascular Research: “Apparent risks of postural orthostatic tachycardia syndrome diagnoses after COVID-19 vaccination and SARS-Cov-2 Infection.”

Johns Hopkins Medicine: “COVID-19 and POTS: Is There a Link?” “Postural Orthostatic Tachycardia Syndrome (POTS).”

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