Impact of COVID-19 on postural orthostatic tachycardia syndrome (POTS)

Dulal, D., et al. (2025) summarised by Nikky Yusifova

Introduction

This article examines the prevalence of postural orthostatic tachycardia syndrome (POTS) in individuals recovering from COVID-19. POTS is a condition characterized by an abnormal increase in heart rate upon standing and can be accompanied by symptoms such as dizziness, fatigue, and even fainting. Furthermore, individuals with Long COVID—a condition in which symptoms persist for at least two months—are experiencing POTS and developing chronic health issues. Consequently, this can lead to significant impairment in daily functioning and negatively impact their lifestyle.

Summary

Despite the origin of POTS being not yet fully understood, it has a significant link to viral infections in its development. Previous studies have found that viral infections such as influenza, Epstein-Barr virus, and COVID-19 can trigger POTS. Post-viral POTS may be triggered by COVID-19 in previously healthy individuals. Although the mechanism of POTS in post-COVID-19 patients is still under investigation, it is suggested that viral infection causes cell damage, persistent inflammation, and consequent effects on the cardiovascular system.

This research examined data from electronic records of 64 healthcare organizations in the USA, encompassing more than 65 million patients. Using sensitive statistical analysis, the researchers observed several trends in pre- and post-COVID results. While the proportion of females increased in POTS prevalence in the post-COVID group, a decrease was observed among males compared to the pre-COVID group. Interestingly, comorbidities such as type 2 diabetes, hypertension, heart failure, and pulmonary and kidney diseases were less frequently identified in post-COVID patients with POTS. This trend suggests that COVID-19 contributes to the onset of POTS in patients without prior risk factors or associated conditions.

In this study, patients with Long COVID showed an increase in POTS cases. Symptoms such as tachycardia, fatigue, and exercise intolerance persisted long after the acute phase of COVID-19. However, multiple studies suggest that Long COVID shares several overlapping symptoms with POTS, including fatigue, exercise intolerance, and orthostatic intolerance, making it difficult to distinguish between the two conditions. Additionally, the overlapping symptoms of POTS and Long COVID with many other conditions contribute to underdiagnosis, leading to suboptimal healthcare outcomes.

Conclusion

This research demonstrated a significant increase in POTS cases among patients with post-COVID or Long COVID conditions. The study suggests a wider application of POTS diagnosis in post-COVID patients, which may increase public awareness and improve healthcare outcomes for affected individuals. Screening and follow-up care for POTS should be prioritized, particularly for early identification and management.

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