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COVID-19 And Postural Orthostatic Tachycardia Syndrome (POTS): Causes, Symptoms And Treatments

Postural orthostatic tachycardia syndrome (POTS) is a common nervous system disorder in which a person feels symptoms like dizziness, lightheadedness, tremulousness, increased heartbeat, weakness, fatigue, blurred vision and exercise intolerance whenever they stand up or tilt their head up from a reclining position. The symptoms, however, may be relieved when they sit or lay back down. [1]

POTS significantly affects premenopausal women and young adults but can affect people of all age groups. People with the conditions often observe a high degree of functional impairment accompanied by a decrease in their quality of life.

POTS has become a topic of conversation due to its link to the COVID-19 infection. This is because several patients complained of experiencing orthostatic intolerance symptoms, such as those aforementioned, a few months after the COVID-19.

Though POTS is common after many bacterial and viral infections, with the increase in the number of POTS patients after acute COVID-19 infection, researchers believe that coronavirus can cause persistent neurologic and cardiovascular disorders after the infection. [2]

In This article, we will discuss causes, symptoms and other details about POTS. Take a look.

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Causes Of Postural Orthostatic Tachycardia Syndrome

The causes of POTS differs from person to person and there's no exact cause for the origin of this condition. Some of the common causes of POTS based on studies are:

  • Neuropathic: It is characterised by damage to the small nerve fibres, especially of the lower limb that results in poor blood supply to the area.
  • Hyperadrenergic: Around 30-60 per cent of patients with POTS fall under this category. It is characterised by increased norepinephrine levels (stress hormones) in the blood, leading to symptoms such as heart palpitations, anxiety, hypertension and tachycardia. [3]
  • Hypovolemic: It is characterised by low levels of renin and aldosterone levels (enzymes that regulate the blood pressure. It also causes excessive water loss in the body.
  • Autoimmune: It is characterised by increased autoantibodies (type of antibodies that target own organs and tissues). [4]

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Symptoms Of Postural Orthostatic Tachycardia Syndrome

Common symptoms of POTS include:

  • Heart palpitations
  • Tachycardia or fast heartbeat (greater than or equal to 30 beats/min within 10 minutes of standing)
  • Chronic fatigue
  • Sleep disturbances
  • Dizziness
  • Bloating
  • Tremors
  • Nausea
  • Anxiety
  • Vision changes
  • Depression
  • Fainting
  • Cognitive impairment
  • Lightheadedness
  • Bladder complaints
  • Urinary symptoms

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COVID-19 And Postural Orthostatic Tachycardia Syndrome

COVID-19 is an ongoing pandemic and the number of infections is rising day by day. People who are diagnosed positive for COVID-19 are experiencing a range of symptoms, both during and post-COVID infection.

POTS is also one of the post-COVID-19 symptoms. It involves dysfunctioning of the autonomic nervous system, nerves that control the body's non-voluntary actions such as heartbeat, sweating and blood pressure.

A case report published in the American College of Cardiology talks about three Swedish patients who were confirmed with POTS three months after the COVID-19 infection, with no prior history of the condition. The symptoms may last for long and cause long-term complications, as they continue to grow without proper diagnosis and treatment. [5]

However, with appropriate diagnosis and treatments, the symptoms can get improved. Also, the treatment may vary from individual to individual.

Risk Factors Of Postural Orthostatic Tachycardia Syndrome

According to a study, POTS can be triggered by the following conditions, following COVID-19 infection: [6]

  • Surgery
  • Pregnancy
  • Infection, viral or bacterial infections such as Epstein-Barr virus, influenza, and Borrelia burgdorferi infection.
  • Concussion
  • Any autoimmune disorder such as Sjogren's syndrome.

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Diagnosis Of Postural Orthostatic Tachycardia Syndrome

Diagnosis of PTOS is carried out based on the signs and symptoms of the patients. A medical expert confirms the diagnosis by the medical history of the patient, severity, time of onset and other details.

This is because the signs can be confused with symptoms of other medical conditions such as structural heart defects, pulmonary embolism, cardiac arrhythmias, myocardial infarction, anaemia, adrenal insufficiency, systemic lupus erythematosus, diabetes mellitus, epilepsy and many others. [1]

The primary diagnostic method includes a head-up tilt test in which the patient is asked to tilt the head up for around 10 minutes and then their heartbeat is measured.

For some selected patients, the other tests following head-up tilt include blood count, thyroid functions test, 24-hour Holter monitor, Detailed autonomic testing, tilt-table testing, transthoracic echocardiogram and exercise stress testing. [7]

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Treatment Of Postural Orthostatic Tachycardia Syndrome

As there is no exact cause of POTS and the cause varies from person to person, the treatment can be a combination of approaches, both nonpharmacologic and pharmacologic.

Also, the long-term treatment method of POTS is not evaluated as around 50 per cent of the patients fully recovered from the condition within a span of five years.

Medications are the commonly used treatment method for PTOS. these medications include beta-blockers, fludrocortisone, midodrine, pyridostigmine and central sympatholytic agents.

Other recommended treatment methods include:

  • Regular and progressive exercise program.
  • Avoiding the triggers such as exposure to infections.
  • Uptake of 2-3 litres of water and 10-12 g of salt daily.
  • Regular blood pressure check.
  • Cardiac rehab program.
  • Small and frequent meals
  • A high-fibre diet to prevent glucose spike
  • Maintaining a proper sleep schedule.
  • Managing stress and anxiety through mindfulness exercises or therapies.
  • Get support from groups with the same medical condition.