POTS Symptoms After COVID: What This Means for Lyme Disease Patients
POTS may develop after viral illness.
Long COVID and Lyme disease share autonomic symptom patterns.
Fatigue, dizziness, and exercise intolerance may persist for months.
POTS symptoms after COVID have drawn increasing attention as researchers recognize the long-term autonomic effects of post-infectious illness.
Patients recovering from COVID-19 may develop fatigue, dizziness, postural tachycardia, exercise intolerance, brain fog, and orthostatic symptoms similar to those seen in Lyme disease dysautonomia.
This overlap is important because postural orthostatic tachycardia syndrome (POTS) has long been recognized after infections including Epstein-Barr virus, influenza, and Borrelia burgdorferi, the bacteria associated with Lyme disease.
For a broader overview of autonomic dysfunction in Lyme disease, visit our Autonomic Dysfunction in Lyme Disease guide.
POTS and Orthostatic Symptoms After COVID
Blitshteyn and Whitelaw described a group of patients who developed orthostatic intolerance (OI) and POTS symptoms following COVID-19 infection.
Patients evaluated at a Dysautonomia Clinic demonstrated evidence of autonomic dysfunction based on tilt-table testing or a 10-minute stand test.
The study included patients with presumed COVID-19 rather than requiring laboratory-confirmed infection alone.
Before COVID-19 infection, none of the patients had chronic orthostatic intolerance, and all had previously been functional and employed.
Persistent Symptoms and Functional Impairment
After the acute infection resolved, many patients continued experiencing fatigue, dizziness, exercise intolerance, postural tachycardia, and autonomic symptoms that became chronic and disabling.
Additional symptoms reported in the study included:
- Brain fog and cognitive dysfunction
- Panic attacks
- Neuropathic pain
- Sleep disruption
- Headaches
- Chest tightness
- Palpitations
- Temperature dysregulation
- Gastrointestinal symptoms
Most patients still reported residual symptoms 6 to 8 months after COVID-19 infection, although some improved with treatment.
These persistent symptom patterns may resemble those reported in post-treatment Lyme disease syndrome (PTLDS) and other post-infectious conditions.
What This Means for Lyme Disease Patients
The overlap between Long COVID and Lyme disease is clinically important because both illnesses may involve autonomic dysfunction, neuroinflammation, exercise intolerance, and persistent neurologic symptoms.
Patients with Lyme disease dysautonomia commonly report:
- Lightheadedness
- Rapid heart rate when standing
- Exercise intolerance
- Temperature sensitivity
- Brain fog
- Palpitations
- Fatigue
- Gastrointestinal slowing
Some patients may have pre-existing autonomic vulnerability that becomes amplified after infection, concussion, inflammation, or prolonged physiologic stress.
For additional discussion of cognitive symptoms and autonomic overlap, see Neuropsychiatric Lyme Disease.
Possible Autoimmune and Inflammatory Mechanisms
The authors noted that some patients demonstrated abnormalities involving inflammation, autoimmunity, or cardiopulmonary testing.
These findings support growing interest in whether post-infectious autonomic disorders may involve inflammatory or immune-mediated mechanisms.
Researchers continue studying cytokines, autoantibodies, autonomic signaling, and neuroimmune dysfunction in Long COVID, POTS, and persistent Lyme-related illness.
This evolving framework may help explain why some patients continue experiencing disabling symptoms long after the initial infection appears resolved.
Why Post-Infectious Dysautonomia Matters
POTS and autonomic dysfunction can significantly impair quality of life, exercise tolerance, cognition, and daily function.
Recognition matters because patients with post-infectious dysautonomia are often told their symptoms are anxiety-related, stress-related, or unexplained despite measurable physiologic abnormalities.
The growing recognition of autonomic dysfunction after COVID-19 may also help clinicians better understand similar symptom patterns in Lyme disease and other post-infectious syndromes.
Frequently Asked Questions
Can COVID cause POTS symptoms?
Yes. Some patients develop POTS or orthostatic intolerance after COVID-19 infection, including fatigue, dizziness, exercise intolerance, and rapid heart rate when standing.
What is the connection between POTS and Lyme disease?
POTS and autonomic dysfunction have also been reported in Lyme disease patients, particularly those with persistent neurologic or post-infectious symptoms.
Can autonomic dysfunction persist after infection?
Yes. Some patients continue experiencing autonomic symptoms for months after viral or bacterial infections.
What symptoms are common in post-infectious dysautonomia?
Common symptoms include fatigue, dizziness, brain fog, exercise intolerance, palpitations, gastrointestinal symptoms, and orthostatic intolerance.
Why is post-infectious POTS important?
Recognition of post-infectious dysautonomia may improve diagnosis, validation, and management of persistent autonomic symptoms.
Clinical Takeaway
POTS symptoms after COVID highlight the growing recognition of post-infectious autonomic dysfunction across multiple illnesses, including Lyme disease.
Fatigue, dizziness, exercise intolerance, brain fog, and orthostatic symptoms may reflect measurable autonomic dysfunction rather than simple deconditioning or anxiety alone.
Related Articles
POTS: An Autonomic Disorder in Lyme Disease Patients
POTS Patients With Brain Fog Have Neurocognitive Deficits
Could POTS and Lyme Disease Patients Suffer Impaired Cognitive Function When Standing?
Persistent Lyme Disease
Recovery From Lyme Disease
References
- Blitshteyn S, Whitelaw S. Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after COVID-19 infection: a case series of 20 patients. Immunol Res. 2021;69(2):205-211.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
