Postural orthostatic tachycardia syndrome (POTS) is considered to be a major phenotype in the new post-acute COVID-19 syndrome


In mid-2020, a new group of patients, so-called post-COVID-19 long-haulers, emerged.

These individuals were constantly tired, incapable of work, often young or middle-aged women, with multiple symptoms, including heart palpitations, tachycardia, orthostatic and exercise intolerance, and chest pain 1.

Many physicians, cardiologists and neurologists realized that some of these symptoms were identical to those of postural orthostatic tachycardia syndrome (POTS), as were patient responses to cardiovascular autonomic tests2. Other variations of cardiovascular autonomic dysfunction, such as inappropriate sinus tachycardia, were also reported 3.

POTS is considered to be a major phenotype in the new post-acute COVID-19 syndrome, with an estimated prevalence of ~30% among highly symptomatic patients 4, but other forms of cardiovascular dysautonomia, such as orthostatic intolerance or hypotension and vasovagal reflex susceptibility, have been also reported 5.

The clinical update was published in the peer reviewed journal: Nature Reviews Cardiology.

The two main types of cardiovascular autonomic dysfunction — local and global — usually overlap. Postural orthostatic tachycardia syndrome and inappropriate sinus tachycardia are the most prevalent phenotypes, found in ~30% of highly symptomatic patients with post-acute coronavirus disease 2019 (COVID-19) syndrome. Peripheral circulatory disorders are thought to stem from microvascular and endothelial dysfunction and can lead to local symptoms such as headache, cognitive impairment (‘brain fog’), chest pain (angina-like symptoms), dyspnoea, heat or cold intolerance, Raynaud-like phenomena and venous pooling. Relative or absolute hypovolaemia can be present.

Postural tachycardia syndrome (PoTS)

Postural tachycardia syndrome (PoTS) is an abnormal increase in heart rate that occurs after sitting up or standing. Some typical symptoms include dizziness and fainting.

It’s sometimes known as postural orthostatic tachycardia syndrome.

PoTS affects a range of people but is most common in girls and women aged 15 to 50.

Some people have mild symptoms, while others find the condition affects their quality of life. PoTS often improves gradually over time, and there are some medicines and self-care measures that can help.

What happens in PoTS

Normally when you sit up or stand, gravity pulls some of your blood down to your belly area, hands and feet.

In response, your blood vessels quickly narrow and your heart rate increases slightly to maintain blood flow to the heart and brain, and prevent blood pressure dropping.

This is all done without needing to think about it, by the autonomic nervous system – the nervous system in charge of automatic body functions.

In PoTS, the autonomic nervous system does not work properly. There’s a drop in blood supply to the heart and brain when you become upright and the heart races to compensate for this.

Symptoms of PoTS

You can develop PoTS suddenly, or it can begin gradually.

You can sometimes get symptoms almost immediately, or a few minutes after sitting up or standing. Lying down may relieve some of the symptoms.

Typical symptoms of PoTS include:

Some people notice that feeling hot, eating, strenuous exercise or having a period can make their symptoms worse.

When to get medical advice

See a GP if you think you have PoTS.

The symptoms can have a number of causes, such as medicine or low blood pressure, so it’s a good idea to get a proper diagnosis. Sometimes it can be misdiagnosed as anxiety or panic attacks.

Some doctors may not be aware of PoTS, so it may help to print out this page and take it with you to your appointment. A GP will probably need to refer you to a specialist for tests (see below).

PoTS UK (a charity for people affected by PoTS) has a list of doctors with an interest in PoTS that you can use to find a specialist near you. You cannot usually self-refer to these doctors, but you could discuss a referral with a GP.

Tests for PoTS

PoTS is diagnosed if your heart rate increases by 30 beats a minute (bpm) or more (40bpm in those aged 12 to 19) usually within 10 minutes of standing. This increase continues for more than 30 seconds and is accompanied by other symptoms of PoTS.

You may have a range of tests to confirm a diagnosis and rule out other conditions, including:

  • tilt table test – your heart rate and blood pressure are measured while you lie on a specially designed bed that can be titled upright. The measurements are taken several more times while the bed is slowly tilted into a more upright position
  • active stand test – your heart rate and blood pressure are measured after lying down, immediately upon standing, then after 2, 5 and 10 minutes
  • an electrocardiogram (ECG) – a test of your heart’s electrical activity
  • an echocardiogram – an ultrasound scan of your heart
  • 24-hour ambulatory blood pressure and heart rate monitoring – small devices attached to your belt take regular readings while you’re doing normal activities
  • blood tests – to test your kidney, liver and thyroid function, and measure blood count and your calcium and glucose levels

Treatments for PoTS

Self-care measures can sometimes help to reduce the symptoms of PoTS. If these do not work, you may need to take medicine.

Treating an episode

If you suddenly feel faint or dizzy, you can try countering the fall in blood flow by:

  • lying down and, if you can, raising your legs
  • crossing your legs in front of each other while standing, rocking up and down on your toes, clenching your buttocks and tummy muscles and/or clenching your fists if you’re unable to lie down

Reducing your symptoms

You may be able to reduce your symptoms in the long term if you:

  • drink plenty of fluids until your urine is pale yellow
  • keep active, but pace yourself and choose your exercise carefully – swimming, rowing, lower limb resistance training, walking, jogging and pilates can help you keep fit and build muscle (strong calf muscles should help pump blood back to your heart)
  • elevate the head end of your bed, so you’re not sleeping fully horizontal
  • try wearing support tights or other forms of compression clothing, to improve blood flow in your legs
  • avoid long periods of standing
  • rise slowly after lying down – sit for a while before standing
  • avoid drinking lots of caffeine or alcohol
  • include more salt in your diet, however this is not advisable if you have high blood pressure or kidney or heart disease, so ask your specialist first

Find out more from the charity Syncope Trust And Reflex anoxic Seizures (STARS) on diagnosis and management of PoTS, and PoTS UK about self-management programmes.


There’s no single medicine used for treating PoTS, but your specialist might suggest trying:

Causes of PoTS

Sometimes the cause of the problem with the nervous system in people with PoTS is unknown.

Teenagers will sometimes develop PoTS and find it gradually disappears a few years later. Sometimes it can develop suddenly after a viral illness or traumatic event, or during or after pregnancy.

Some of the other known causes are:

PoTS also happens quite commonly alongside chronic fatigue syndrome.

reference link :,as%20postural%20orthostatic%20tachycardia%20syndrome.



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