Cardiovascular Consequences of Long COVID and Postural Orthostatic Tachycardia Syndrome
Long COVID, a condition characterised by ongoing symptoms after recovery from acute COVID-19, has been linked to Postural Orthostatic Tachycardia Syndrome (POTS), a form of dysautonomia. POTS affects the autonomic nervous system, which controls key bodily functions such as heart rate, breathing, and digestion.
Before the COVID-19 pandemic, approximately 1-3 million people in the U.S. had POTS, according to Dysautonomia International. However, since the start of the pandemic, there has been a steep increase in POTS cases, particularly among those experiencing long COVID.
Dr. Fedorowski and his colleagues at the Karolinska University Hospital in Sweden have seen a doubling or tripling of referrals for POTS rehabilitation since the start of the pandemic. Similarly, Dr. Chung and his colleagues at Johns Hopkins have also seen at least twice or three times more referrals at their clinic since the pandemic began, compared with pre-pandemic numbers.
In a study analysing data from a large cohort of individuals with COVID-19, there was an increased risk of a whole range of cardiovascular outcomes even in those not admitted to hospital with severe COVID-19 - that is, even in milder cases of the disease. This suggests that the cardiovascular impact of COVID-19 and long COVID can be difficult to pinpoint at first, making treatment challenging.
People who most commonly receive a diagnosis of POTS in long COVID are young females. The mechanisms behind POTS remain unclear, but ongoing research is searching for the likeliest explanations. Some research suggests that POTS can develop following a viral illness and that sometimes genetic factors may be at play. There is also some suggestion that the high levels of stress that women in these demographics often encounter might play a role in the development of POTS associated with long COVID.
POTS is characterised by symptoms such as lightheadedness, brain fog, fatigue, headaches, blurry vision, heart palpitations, and nausea. Diagnosis is confirmed by a sustained heart rate increase of over 30 bpm upon standing (without blood pressure drop), accompanied by palpitations and dizziness.
Treatment strategies for POTS in long COVID include increasing fluid intake (≥2.5 L/day) and sodium chloride intake (≥7 g/day) to expand blood volume. Beta blockers like atenolol may be used to control excessive heart rate, while vasoconstrictors such as midodrine can improve orthostatic tolerance and reduce symptoms of dizziness. Additional treatments explored experimentally include ivabradine, which selectively reduces heart rate without affecting blood pressure. Structured management approaches address cardiovascular deconditioning through graded exercise and autonomic rehabilitation.
Research on POTS conducted before the COVID-19 pandemic further indicates that the syndrome can be associated with various chronic conditions, including diabetes, sarcoidosis, and lupus, as well as with aggressive treatments, such as chemotherapy.
Long COVID causes a diverse array of symptoms that affect multiple organ systems, with impact on functioning and ability to work. The risks of cardiovascular disease associated with COVID-19 were evident regardless of age, race, sex, and other cardiovascular risk factors.
In the U.K., Dr. Kavi noted a significant increase in POTS referrals since the start of the pandemic. Furthermore, people with POTS have elevated inflammatory biomarkers, all of which may suggest a state of chronic inflammation.
Continued research is refining mechanistic understanding and optimal therapy protocols for POTS in long COVID. A study that appeared in February 2022 suggests that people who develop COVID-19 have an increased risk of experiencing cardiovascular problems a year after the initial disease. Another study published in February 2022 in Cells found that people with POTS have platelet storage pool deficiency, a phenomenon linked to symptoms such as frequent nosebleeds, dysmenorrhea, easy bruising, and anemia.
In summary, long COVID can cause dysautonomia including POTS, with cardiovascular effects mediated by immune and structural cardiac changes. Treatment is multidisciplinary, involving hydration, salt loading, beta blockers, vasoconstrictors, and tailored rehabilitation to improve quality of life and functional capacity.
1.Long COVID, a condition marked by persistent symptoms following recovery from acute COVID-19, has been linked to POTS, a form of dysautonomia often associated with cardiovascular outcomes, even in milder cases of the disease.
2.Young females are most commonly diagnosed with POTS in long COVID, a condition characterized by symptoms such as lightheadedness, heart palpitations, and fatigue, which can be managed through treatments like hydration, beta blockers, vasoconstrictors, and rehabilitation.
3.Research indicates that long COVID can lead to chronic inflammation, as well as increased risks of cardiovascular disease and associated conditions like diabetes, sarcoidosis, and lupus, highlighting the importance of continued study and tailored treatment strategies for this complex post-COVID-19 syndrome.
