POTS symptoms are increasingly reported after COVID-19 — and the pattern mirrors what Lyme disease patients have experienced for years. A case series by Blitshteyn and Whitelaw describes 20 patients who developed autonomic dysfunction following COVID-19 infection.
POTS After Infection Is Not New
POTS typically occurs after viral or bacterial infections, including Epstein-Barr virus, influenza, and Borrelia burgdorferi — the causative agent of Lyme disease. It can also be triggered by surgery, pregnancy, or concussion.
The recognition of POTS symptoms in COVID-19 patients has brought new attention to a pattern that Lyme disease clinicians have observed for years: infection triggers autonomic dysfunction that persists long after the acute illness resolves.
The Study: 20 COVID-19 Patients with POTS
The patients evaluated at a Dysautonomia Clinic had evidence of orthostatic intolerance based on a 10-minute stand test or tilt table test. Out of 20 participants, 6 had pre-existing minor autonomic symptoms such as occasional dizziness, syncope, or palpitations. But prior to COVID-19, none had chronic orthostatic intolerance, and all were fully functional and employed.
After resolution of the COVID-19 infection, most patients experienced fatigue, postural tachycardia, orthostatic intolerance, dizziness, and exercise intolerance that were chronic and disabling.
Persistent Symptoms at 6-8 Months
Most patients (85%) self-reported residual symptoms 6-8 months after COVID-19, although many felt they had improved with treatment. Only 3 patients fully recovered. Eight were able to work part- or full-time.
Six patients had mild abnormalities on cardiac or pulmonary testing. Four had elevated markers of autoimmunity or inflammation — suggesting an underlying autoimmune or inflammatory process affecting cardiopulmonary, neurologic, and immunologic systems.
Less common symptoms included hypersomnolence, panic attacks, anosmia, ageusia, headaches, neuropathic pain, hypertension, chest tightness, recurrent fevers, weight loss, diarrhea, and oxygen desaturation.
Treatment
Sixteen of the 20 patients (80%) were treated with pharmacotherapy including beta blockers, fludrocortisone, midodrine, ivabradine, and medications for comorbid conditions such as headaches, neuropathic pain, or allergic symptoms associated with mast cell activation disorder.
What This Means for Lyme Disease Patients
The authors conclude that POTS and other autonomic disorders can follow COVID-19 in previously healthy, non-hospitalized patients — causing significant disability 6-8 months after acute infection. They suggest further studies are needed to determine whether post-COVID autonomic disorders are rooted in autoimmunity.
This matters for Lyme disease patients because the mechanism is the same: infection triggers autonomic dysfunction that persists after the acute illness. The growing recognition of POTS in Long COVID is validating what Lyme patients have reported for decades.
For a comprehensive overview of the POTS and Lyme connection, see POTS and Lyme Disease: Why Your Heart Races.
Frequently Asked Questions
Can COVID-19 cause POTS?
Yes. This case series found that previously healthy patients developed POTS symptoms following COVID-19, with 85% still experiencing symptoms 6-8 months later.
Is POTS after COVID-19 similar to POTS after Lyme disease?
Yes. Both involve post-infectious autonomic dysfunction. The mechanism — infection triggering persistent nervous system dysregulation — is the same.
Do POTS symptoms after COVID-19 improve?
Many patients improved with treatment, but only 3 out of 20 fully recovered at 6-8 months. Most reported residual symptoms despite pharmacotherapy.
What treatments were used for post-COVID POTS?
Beta blockers, fludrocortisone, midodrine, and ivabradine were used, along with medications for headaches, neuropathic pain, and mast cell activation.
Why does this study matter for Lyme disease patients?
The recognition of POTS in Long COVID validates the autonomic dysfunction Lyme patients have experienced for years. It demonstrates that post-infectious autonomic disorders are documented, measurable, and not psychological.
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.
Related Reading
- POTS and Lyme Disease: Why Your Heart Races
- What Is POTS (Postural Orthostatic Tachycardia Syndrome)?
- POTS in Lyme Disease: An Autonomic Disorder Explained
- POTS and Brain Fog
- Long COVID and Lyme Disease: What Patients Need to Know
- Autonomic Dysfunction in Lyme Disease
- Lyme Disease Fatigue: Causes, Duration and Recovery
- Medical Dismissal and Lyme Disease
