Case report looks at POTS as 'long-haul' symptom months after COVID-19 infection

Months after a COVID-19 infection, patients may experience "long-haul" symptoms like rapid heart rate, dizziness upon standing and lightheadedness consistent with a diagnosis of postural orthostatic tachycardia syndrome (POTS), according to a clinical case report in JACC: Case Reports.

POTS is a condition that's most commonly known for causing dizziness upon standing, but symptoms can include palpitations, headache, fatigue and blurred vision. It usually affects young and middle-age women. The causes of POTS are usually undetermined, but it can be precipitated by viral illness, severe infection or trauma. There is no cure or standard treatment, but it can be managed with self-care and some medications.

In this case report, researchers discuss three Swedish patients who were diagnosed with POTS more than three months after presumed COVID-19 infections. All three patients experienced COVID-19-like symptoms in the spring of 2020, but not all sought medical attention or received COVID-19 tests at the time of their symptoms. Later that summer and fall, all three patients began experiencing symptoms of POTS, including extreme fatigue, headache, nausea and dizziness. POTS was confirmed using active standing and head-up tilt tests.

"As reports of COVID-19 patients being impacted by long-term symptoms unrelated to their original diagnosis continue to grow, it's important to raise awareness of POTS as a possible long-term complication," said Madeleine Johansson, MD, Ph.D., Department of Clinical Sciences, LundUniversity, Malmo, Sweden and one of the lead authors of the case report. "Much remains unknown about the specific mechanisms responsible for the POTS-like symptoms in post-COVID-19 patients or how long these symptoms will last, but chronic symptoms are expected in a subset of patients based on this initial clinical experience."

The researchers note that a negative COVID-19 test does not exclude the patient from having been infected with COVID-19 and "ought to be interpreted with caution in the context of typical symptoms." In addition, other causes of POTS symptoms should be excluded, including dehydration, other infections, anxiety and anemia.