COVID-19 and POTS: Is There a Link?
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While many people recover from COVID-19 within a few weeks, others experience lingering symptoms that last for months. Researchers are still working to understand why this happens. In some cases, people with “long-haul COVID” may actually be developing a condition known as postural orthostatic tachycardia syndrome (POTS).
POTS is a disorder of the autonomic nervous system that affects involuntary functions such as heart rate and blood pressure, often causing symptoms when a person moves from lying down to standing.
Christina Kokorelis, M.D., a physical medicine and rehabilitation specialist, explains what is currently known about post-COVID POTS and how it is diagnosed.
Key Points
- Some people recovering from COVID-19 may develop POTS, an autonomic nervous system disorder that can cause fatigue, rapid heart rate, dizziness and brain fog.
- COVID-19 may act as a trigger for POTS, even in people who had mild infections.
- Because POTS symptoms overlap with other post-COVID complications, a careful medical evaluation is necessary to rule out other causes.
What is post-COVID POTS?
POTS can have a variety of triggers, including viral or bacterial infections. Researchers believe that SARS-CoV-2, the virus responsible for COVID-19, may act as one such trigger.
Since the pandemic began, clinicians have noticed an increasing number of patients recovering from COVID-19 who later develop symptoms that overlap with POTS, including brain fog, rapid heart rate (tachycardia) and severe chronic fatigue. Because of these overlapping symptoms, clinicians began evaluating some people who have long-haul COVID for autonomic dysfunction.
The autonomic nervous system regulates many processes the body performs automatically, including heart rate, blood pressure, sweating and temperature regulation. When this system does not function properly, it can cause a wide range of symptoms that can be shared by other medical conditions.
Because POTS is still unfamiliar to many clinicians, symptoms may sometimes be attributed solely to lingering effects of COVID-19, or even dismissed as psychological. However, POTS can significantly affect quality of life and requires targeted treatment, making an accurate diagnosis essential.
Are people with more severe cases of COVID-19 more likely to develop POTS?
Research in this area is ongoing. However, many people who develop post-COVID POTS initially had mild COVID-19 infections before their chronic symptoms began.
I have lingering COVID-19 symptoms. How do I know if it is POTS?
If you have recovered from COVID-19 but continue to experience persistent symptoms, it is important to discuss them with your doctor. Symptoms that may suggest POTS include:
- Severe or persistent fatigue
- Lightheadedness or dizziness when standing
- Brain fog
- Memory or concentration difficulties
- Shakiness
- Headaches
- A rapid heart rate with minimal physical activity
- Chronic nausea or vomiting
Doctors will first check if you have other complications related to COVID-19.
“Because COVID-19 can cause conditions such as blood clots or lung scarring, which can produce symptoms similar to POTS, we are careful to rule out those possibilities first,” explains Kokorelis.
Multispecialty POTS programs, such as the one at Johns Hopkins, include physicians from physical medicine and rehabilitation, pulmonology, critical care and neurology, who often collaborate to evaluate patients with persistent post-COVID symptoms. If other causes are excluded, patients may be referred to specialists experienced in diagnosing autonomic disorders such as POTS.
What is treatment like for post-COVID POTS?
Early treatment typically focuses on improving blood circulation and increasing blood volume, often referred to as volume expansion therapy. This may involve both medication-based and non-medication approaches.
Treatment plans are tailored based on each person’s symptoms and medical history. Common strategies include:
- Increasing hydration
- Dietary adjustments, including increased salt intake
- Medications that support circulation or regulate heart rate
Physical therapy and carefully structured exercise programs can also be beneficial for improving circulation and conditioning. However, some people need time for symptoms to stabilize before beginning rehabilitation.
Recovery can take time, but persistence is important. “One of the most important principles in treatment is not giving up,” Kokorelis emphasizes.
Treatment The Johns Hopkins POTS Program
The Postural Orthostatic Tachycardia Syndrome Program at Johns Hopkins brings together specialists in rehabilitation, cardiology, neurology, physical therapy and other fields to provide well-rounded care for people with POTS. Our team has developed treatment protocols for children and adults to help you effectively manage symptoms and have more control over this disabling and unpredictable condition.
What if I had POTS before getting sick with COVID? Will my condition worsen?
Like many viral illnesses, COVID-19 can temporarily worsen existing POTS symptoms. This flare may make recovery more difficult in the short term.
Because COVID-19 is a relatively new disease, researchers are still studying its long-term effects in people who already have POTS. “In the meantime, people who have POTS and get COVID-19 should work closely with their health care team to adjust medications, hydration strategies and dietary plans as needed during recovery,” suggests Kokorelis.
What is next for post-COVID POTS research?
The COVID-19 pandemic has created an unprecedented opportunity for researchers studying POTS. In many people with POTS, the original trigger is unknown. In contrast, people who develop POTS after COVID-19 have a clearer timeline linking infection to the start of symptoms.
By studying these patients and comparing them with people who recovered fully from COVID-19, researchers hope to better understand how POTS develops, and ultimately improve treatments for everyone living with the condition.
Medically reviewed by Christina Kokorelis, M.D.
