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Dr. Marek Derkacz, MBA
POTS in Long-COVID: The hidden culprit of chronic fatigue and dizziness
MedExpress Team
Dr n. med. Marek Derkacz
Published Dec. 27, 2024
Long-COVID syndrome, also known as chronic sequelae of SARS-CoV-2 infection, remains a serious clinical challenge. It affects 10-30% of patients, causing persistent symptoms after the acute phase of infection. Among the various disorders seen in Long-COVID, POTS, postural orthostatic tachycardia syndrome, which affects up to 30% of patients with more severe symptoms of the syndrome, occupies an important place.
POTS is a form of dysautonomia, a disorder of the autonomic nervous system manifested by an increase in heart rate by a minimum of 30 beats per minute when the body is upright, without a decrease in blood pressure. Symptoms of POTS include:
Heartworms,
Dizziness and weakness when changing positions,
Chronic fatigue,
Brain fog (problems with concentration and memory),
Headaches and muscle weakness.
Interestingly, POTS symptoms can appear both during COVID-19 infection and many months later, despite recovery from the acute phase.
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Diagnosis and treatment of POTS in Long COVID
POTS can be diagnosed in the doctor's office, based on orthostatic tests. In inconclusive cases, a tilt-table test is worth considering. Treatment is based on strategies familiar from classic POTS:
Blood pressure support:
- Salt supplementation and adequate hydration,
- Use of compression stockings to improve venous circulation.
Physical activity:
- Despite concerns about exhaustion, the 2024 study suggests that graded physical activity does not harm Long COVID patients, and in fact promotes recovery. Moderate-intensity exercise, similar to that recommended for ME/CFS and fibromyalgia, is indicated.
Pharmacotherapy:
- Propranolol and midodrine effectively relieve orthostatic symptoms,
- Low-dose naltrexone (LDN), increasingly being studied in Long COVID, has shown potential in reducing the neuroinflammatory substrate of dysautonomia, consistent with its efficacy in fibromyalgia.
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Prognosis and challenges
Although in many patients the symptoms of POTS resolve within 12 months, for some people the disorder becomes a cause of severe limitations in daily functioning. Therefore, it is crucial to further investigate the mechanisms of Long COVID and to develop effective therapeutic strategies to speed up recovery.