POTS After COVID-19: Getting Dizzy When You Stand? | myCOVIDteam

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POTS After COVID-19: Getting Dizzy When You Stand?

Medically reviewed by Patrina Conley-Brown, D.O.
Written by Emily Wagner, M.S.
Posted on September 5, 2023

Have you ever stood up too quickly and suddenly become dizzy or lightheaded? COVID-19 can affect multiple body systems, including your cardiovascular system. Now, doctors and researchers are finding that some people with long COVID (symptoms that linger for weeks or months after a COVID-19 infection) may also have postural orthostatic tachycardia syndrome (POTS). If you become dizzy, have a racing heartbeat, or become short of breath after standing, it may be POTS.

This article will cover what POTS is, the symptoms to look out for, and how common it is after a COVID-19 infection. We’ll also offer some tips for managing POTS and let you know when it’s best to talk to your doctor.

What Is POTS?

POTS is a condition that affects your body’s ability to regulate your heart rate and blood pressure. The acronym POTS stands for:

  • Postural — Your body’s posture or position
  • Orthostatic — Related to being in an upright position (sitting or standing)
  • Tachycardia — A heart rate of over 100 beats per minute
  • Syndrome — A specific set of symptoms

Your autonomic nervous system works hard to make sure blood flows throughout your body at a steady pace. Specifically, your autonomic nervous system coordinates your heart rate and how relaxed or narrowed your blood vessels are. Normally, these adjustments keep everything stable whether you’re standing, sitting, or lying down.

If you have POTS, your body can’t coordinate these actions well, causing your heart rate to jump. POTS symptoms typically appear immediately after sitting or standing up, or within a few minutes.

POTS symptoms include:

  • Lightheadedness or dizziness
  • Fainting or near fainting
  • Shortness of breath
  • Fatigue
  • Racing heartbeat or heart palpitations after standing or with mild physical activity
  • Chest pain
  • Bloating
  • Feelings of anxiety or nervousness
  • Excessive sweating
  • Brain fog or trouble with concentration or memory
  • Headaches
  • Trouble sleeping from heart palpitations, chest pain, and excessive sweating

POTS vs. Orthostatic Hypotension

You may have heard of the condition orthostatic hypotension, which also makes you dizzy when you stand up too quickly. Hypotension is the medical term for low blood pressure — meaning this condition involves a drop in blood pressure when you sit or stand up. Typically POTS is not associated with significant changes in blood pressure, but rather it’s the heart rate that is affected most.

A few key signs help doctors diagnose POTS or orthostatic hypotension. A tilt table test measures your blood pressure, heart rate, and heart rhythm while you lay secured on a table. The table is moved into different positions that mimic lying down or standing up — after it’s moved, you’ll have measurements taken again.

If you have POTS, your heart rate will typically increase by 30 beats per minute in the first 10 minutes of standing. Your blood pressure likely won’t change. Doctors will likely diagnose orthostatic hypotension if your blood pressure drops within three minutes after standing.

How Are COVID-19 and POTS Related?

The coronavirus that causes COVID-19 mainly affects your respiratory tract. Common symptoms include cough, shortness of breath, and a runny nose. But did you know that this viral illness can also affect your autonomic nervous system? The autonomic system regulates important body functions we don't consciously control, such as blood pressure and heart rate, breathing, temperature, and metabolism — just to name a few.

How May COVID-19 Cause POTS?

Studies are starting to report that dysautonomia — or dysfunction in your autonomic nervous system — may be a symptom of long COVID. Researchers are not quite sure how COVID-19 causes dysautonomia, but they have a few ideas.

Your immune system is your body’s defense against bacteria and viruses. It creates specialized proteins known as antibodies that tag foreign invaders and infected cells for destruction. This system isn’t perfect, and sometimes it mistakes your own healthy cells and tissues as invaders.

During a COVID-19 infection, you may have an autoimmune reaction that causes your immune system to target your own body. Specifically, your immune system could make proteins that target cells in your autonomic nervous system, leading to dysautonomia. The spike proteins found on the surface of SARS-CoV-2 (the virus that causes COVID-19) may also be toxic to your nervous system and cause POTS.

How Many People With Long COVID Develop POTS?

Doctors and researchers continue to learn more about long COVID and the effects it has on the body. Unfortunately, there currently aren’t many studies reporting how common POTS is with long COVID. Most information comes from small case reports of doctors sharing they diagnosed a person with POTS after a COVID-19 infection.

One small study comes from doctors at the University of Texas Southwestern Medical Center. They tested 50 people with long COVID for POTS and other signs of dysautonomia. In total, 12 percent of participants were diagnosed with POTS. It’s important to note that only 0.2 percent of people in the United States have POTS.

On the other hand, the same study found that 86 percent of participants had normal results or mild symptoms unrelated to POTS. Although this study shows that people with long COVID may be more likely to develop POTS, there were only 50 participants, and it’s hard to draw any definite conclusions from a small sample.

Another online survey of 2,314 adults with long COVID found that 67 percent developed moderate or severe dysautonomia — which could lead to several health conditions, including POTS. Given these results, additional studies should be done to measure how common POTS is in relation to long COVID.

Talk To Your Doctor About POTS and Long COVID

If you’re experiencing symptoms of POTS or the lingering symptoms of long COVID, talk to your doctor. They can make a diagnosis and create a treatment plan for you. The symptoms of POTS and long COVID can look similar to one another — so be sure to let your doctor know all of your symptoms and advocate for yourself.

How Is POTS Managed?

While there’s no cure for POTS at the moment, it can be managed with lifestyle changes and medications. Your doctor can help you determine a safe and appropriate treatment plan based on your overall health.

Your doctor may suggest drinking plenty of fluids throughout the day to increase your blood volume. The more water you have in your bloodstream, the more blood can easily reach your brain and heart. They may also suggest dietary changes such as increasing your salt intake because salt helps your body hold onto water.

If you’re taking dehydrating medications, such as diuretics or certain blood pressure medicines, your doctor should review these prescriptions to see if your dosage should be changed or stopped.

POTS also makes it harder for your body to move blood from your legs and feet upward against gravity. Compression stockings help blood flow back to your heart and throughout your body. Ask your doctor which types they recommend.

You may also be able to adjust your movements to reduce the symptoms of POTS, such as changing positions slowly from sitting to standing. There are also isometric exercises and yoga poses that could be helpful, as well as modest exercise plans. Your doctor can help you learn about movements to maintain cardiovascular balance in POTS and dysautonomia conditions.

Your health care provider may also prescribe medications off-label, or outside of their approved use, to treat POTS. Examples include:

  • Beta-blockers and ivabradine (Corlanor) to help lower your heart rate
  • Midodrine to narrow your blood vessels and push blood throughout your body
  • Fludrocortisone to increase your blood volume

Let your doctor know about any symptoms of POTS you notice, or any symptoms of COVID-19 infection that don’t resolve after four weeks or so. They can help you create a plan to manage your symptoms.

Talk With Others Who Understand

On myCOVIDteam, more than 8,500 members come together to ask questions, give advice, and share their stories with others who understand life with COVID-19 and long COVID.

Have you been diagnosed with POTS or long COVID? How do you manage your symptoms? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Posted on September 5, 2023
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Patrina Conley-Brown, D.O. holds a Bachelor of Science from Vanderbilt University, a Master of Science from the University of South Florida, and a Doctor of Osteopathic Medicine from Nova Southeastern University. Learn more about her here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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