COVID-19 Induced Postural Orthostatic Tachycardia Syndrome (POTS): A Review

Abstract

POTS (Postural Orthostatic Tachycardia Syndrome) is a multisystem disorder characterized by the abnormal autonomic response to an upright posture, causing orthostatic intolerance and excessive tachycardia without hypotension. Recent reports suggest that a significant percentage of COVID-19 survivors develop POTS within 6 to 8 months of infection. Prominent symptoms of POTS include fatigue, orthostatic intolerance, tachycardia, and cognitive impairment. The exact mechanisms of post-COVID-19 POTS are unclear. Still, different hypotheses have been given, including autoantibody production against autonomic nerve fibers, direct toxic effects of SARS-CoV-2, or sympathetic nervous system stimulation secondary to infection. Physicians should have a high suspicion of POTS in COVID-19 survival when presented with symptoms of autonomic dysfunction and should conduct diagnostic tests like the Tilt table and others to confirm it. The management of COVID-19-related POTS requires a comprehensive approach. Most patients respond to initial non-pharmacological options, but when the symptoms become more severe and they do not respond to the non-pharmacological approach, pharmacological options are considered. We have limited understanding and knowledge of post-COVID-19 POTS, and further research is warranted to improve our understanding and formulate a better management plan.

Complete remission with histamine blocker in a patient with intractable hyperadrenergic postural orthostatic tachycardia syndrome secondary to long coronavirus disease syndrome

“…Similarly, treatment for POTS has targeted the symptoms rather than the cause. There have been several case reports suggesting diverse treatments, such as beta-blockers, alpha-blockers, fludrocortisone, ivabradine, midodrine, and methylphenidate, among others [ 20 ]. Nonetheless, it has been difficult to standardize treatment given POTS heterogeneity, comorbidities, and potential side effects of medications.…”

Navigating the Long Haul: A Comprehensive Review of Long-COVID Sequelae, Patient Impact, Pathogenesis, and Management

“…Among the common symptoms of long COVID are fatigue, fever, pain, breathlessness, anxiety, chronic fatigue syndrome, and POTS [21,22]. It is important to note that these symptoms may evolve, and some individuals with long COVID may receive a diagnosis of POTS following coronavirus infection [23]. Several studies have undertaken the task of classifying long-COVID symptoms into distinct clusters.…”

Occult endocrine disorders newly diagnosed in patients with post-COVID-19 symptoms

“…The most common symptom is fatigue and other symptoms include dyspnea on exertion, palpitations, headaches, sleep disturbances, brain fog, taste and smell disturbances, hair loss and numbness 4 , 5 . Some patients with these symptoms have conditions that have been noted to be linked to COVID-19 such as postural orthostatic tachycardia syndrome (POTS) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) 6 , 7 . We previously reported that a large proportion of patients with long COVID met the criteria for ME/CFS 8 .…”