Prior to COVID-19, postural orthostatic tachycardia syndrome (POTS) affected 1 to 3 million Americans—mostly young, athletic women—and was often dismissed by physicians. Many of those physicians are now rethinking their stance on it. Learn more about how POTS is being considered as a long-term symptom of long COVID.*

What is postural orthostatic tachycardia syndrome?

POTS is a condition that involves the autonomic (involuntary) nervous system and the sympathetic nervous system, which activates your body’s fight-or-flight response. It affects your blood flow and can cause light-headedness, fainting, and a rapid increase in heart rate upon standing up from a sitting or reclining position. Sitting or lying back down usually relieves the symptoms. 

“[Physicians] thought it was just anxious, crazy young women,” said Dr. Pam R. Taub, MD, who runs the cardiac rehabilitation program at the University of California, San Diego (UCSD). Fortunately, in light of new case reports showing that POTS is manifesting as a symptom of long COVID, the condition is being taken more seriously.

What causes POTS?

In addition to COVID-19, POTS has also been reported following certain other infections, including Lyme disease and the Epstein-Barr virus. According to the National Institutes of Health (NIH), POTS likely has multiple underlying mechanisms that can vary from person to person. 

The following may all play a part:

• Genetic abnormalities
• Autoimmune disorders
• Low blood volume
• Dehydration
• Combination of these and other conditions

Many POTS patients have reported a significant preceding event that occurs shortly before their POTS onset, such as:

• Viral infection
• Concussion
• Pregnancy
• Surgery
• Puberty

Health professionals have not determined whether POTS should be classified as a single syndrome or as one with various subtypes.  

Who is at risk for POTS?

Prior to COVID-19, the majority of POTS patients were women between the ages of 13- 50, with an average age of 30.2 years. Most were healthy and active before developing POTS, and some were high-performing, even competitive, athletes. 

In addition to viral and other serious infections, pregnancy, and trauma, certain other medical conditions can place you at higher risk for POTS, including:

• Recent history of mononucleosis
• Autoimmune disorders, like Sjogren’s syndrome and Celiac disease
• Serious illness that resulted in hospitalization and prolonged immobility.

If I’ve had COVID-19, will I get POTS?

It is uncertain whether COVID-19 is more likely than other infections to trigger POTS or if the rise in cases only reflects the fact that over 115 million people around the world have been infected. There is no more guarantee that you will develop POTS than any of the other diverse symptoms experienced by COVID long-haulers.

If there is any upside to this new development, said Taub, it’s that “this condition that has been so often the ugly stepchild of both cardiology and neurology is getting some attention.”

More information on POTS can be found in articles on the Science Direct and Cleveland Clinic websites.

*Ward, T. (2021, Mar. 26). Long COVID Brings Welcome Attention to POTS. Medscape. https://www.medscape.com/viewarticle/948174

Much about the novel coronavirus, i.e., COVID-19, is still not fully understood. As research progresses and our knowledge of the virus increases, information can change rapidly. We strive to update all of our articles as quickly as possible, but there may occasionally be some lag between scientific developments and our revisions.