Postural Orthostatic Tachycardia Syndrome (POTS) as a Common Outcome of Long COVID

Postural Orthostatic Tachycardia Syndrome (POTS) has emerged as one of the more common and disabling conditions associated with Long COVIDPersistent symptoms following recovery from acute COVID-19.. It is a form of autonomic nervous system dysfunction where the body struggles to regulate blood flow and heart rate when moving from lying to standing. This results in symptoms such as dizziness, lightheadedness, rapid heartbeat, fatigue, brain fog, nausea, and sometimes fainting.

PrevalenceThe total number of cases in a population at a given time. and Connection to Long COVIDPersistent symptoms following recovery from acute COVID-19.

• A study found that around 79% of individuals with Long COVIDPersistent symptoms following recovery from acute COVID-19. met diagnostic criteria for POTS ¹https://www.contagionlive.com/view/majority-of-patients-with-long-covid-meet-criteria-for-pots
• Another review reported that nearly 80% of Long COVIDPersistent symptoms following recovery from acute COVID-19. patients show symptoms consistent with POTS ²https://www1.racgp.org.au/newsgp/clinical/how-is-pots-related-to-long-covid
• Pediatric specialists have seen a surge in children and teens developing POTS-like symptoms after COVID, even after mild or asymptomatic infections ³https://www.frontiersin.org/articles/10.3389/fped.2022.938030/full

Possible Mechanisms

Researchers believe POTS may result from several overlapping factors triggered by COVID-19A disease caused by the SARS-CoV-2 virus, leading to respiratory illness.:

• Autonomic Nervous System Dysfunction: SARS-CoV-2The virus responsible for the COVID-19 pandemic. may damage or dysregulate the autonomic nervous system ⁴https://pmc.ncbi.nlm.nih.gov/articles/PMC9629292/
• Autoimmune Attack: The virus may cause the body to generate autoantibodies that target nerve receptors or cardiovascular structures ⁵https://www.cardioaragon.com/wp-content/uploads/Postural-orthostatic-tachycardia-syndrome-as-a-sequela-of-covid-19.pdf
• Hypovolemia (low blood volume) and deconditioning from prolonged illness or bed rest can both contribute to the onset or worsening of POTS ⁶https://pmc.ncbi.nlm.nih.gov/articles/PMC9629292/

Impact on Children and Adolescents

• POTS is increasingly diagnosed in teens and young adults, often those who were previously healthy and physically active
• Symptoms like dizziness, tachycardia, and fatigue interfere with school, sports, and normal social development
• Some children go from full activity to requiring wheelchairs or homebound education due to severe orthostatic intolerance ⁷https://www.frontiersin.org/articles/10.3389/fped.2022.938030/full

Treatment and Recovery

Management of POTS generally includes a combination of lifestyle adjustments, medications, and supportive therapies:

• Non-pharmacologic Approaches
  • Increase salt and fluid intake
  • Use compression garments
  • Sleep with the head of the bed elevated
  • Follow a graded physical activity plan, starting with recumbent or horizontal exercises ⁸https://pmc.ncbi.nlm.nih.gov/articles/PMC10792321/
• Medications (when appropriate)
  • Beta blockers
  • Fludrocortisone
  • Ivabradine or midodrine ⁹https://pmc.ncbi.nlm.nih.gov/articles/PMC10792321/
• Supportive Measures
  • Pacing and activity management
  • Mental health care (especially for children and adolescents)
  • School accommodations: hydration access, rest periods, flexible scheduling
• Emerging Therapies
  • Hyperbaric oxygen therapy (HBOT) is being explored for Long COVIDPersistent symptoms following recovery from acute COVID-19. and dysautonomia. It may help by improving oxygen delivery, reducing inflammation, and supporting nervous system recovery ¹⁰https://www.sciencedirect.com/science/article/pii/S1094553924000464

Conclusion

POTS has become a signature feature of Long COVIDPersistent symptoms following recovery from acute COVID-19., particularly affecting adolescents and young adults. While it can be profoundly disabling, early diagnosis and a comprehensive, patient-centered management plan can greatly improve outcomes. As awareness grows and research continues, it’s critical that healthcare providers, schools, and families recognize POTS and respond with both clinical and social support.