POTS in Long COVID and Lyme Disease: Autonomic Dysfunction Compared
Postural Orthostatic Tachycardia Syndrome (POTS) has been reported in both Long COVID and Lyme disease. These conditions share symptoms of autonomic dysfunction, including dizziness, palpitations, fatigue, and cognitive impairment.
In this Inside Lyme Podcast, Dr. Daniel Cameron discusses the American Autonomic Society’s statement on Long-COVID postural tachycardia syndrome and the similarities between POTS in Long COVID and Lyme disease.
The statement was published in Clinical Autonomic Research by Raj and colleagues.¹
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Symptoms of Long COVID and POTS
The American Autonomic Society notes that Long COVID can cause a wide range of persistent symptoms.
“Commonly described symptoms of Long-COVID include breathlessness, palpitations, chest discomfort, fatigue, pain, cognitive impairment (brain fog), sleep disturbance, orthostatic intolerance, peripheral neuropathy symptoms, abdominal discomfort, nausea, diarrhea, joint and muscle pains, anxiety or depression, rashes, sore throat, headache, earache, and tinnitus,” the authors wrote.
When these symptoms occur together with excessive orthostatic tachycardia, patients may be diagnosed with postural orthostatic tachycardia syndrome (POTS).
POTS After COVID-19 Infection
POTS and other autonomic disorders following COVID-19 infection were described in a case series of 20 patients.²
Kanjwal and colleagues described a 36-year-old woman who recovered from COVID-19 but developed fatigue, orthostatic palpitations, chest pain, lightheadedness, headaches, and presyncope three to four weeks later. The diagnosis of POTS was confirmed with an abnormal tilt table test.
The patient improved with a combination of ivabradine along with increased water and salt intake.³
Ivabradine, marketed as Corlanor in the United States, is a heart-rate-lowering medication that inhibits the cardiac pacemaker current (If).⁴
Possible Neurologic Mechanisms
The pathophysiology of Long COVID–related POTS remains unclear.
Researchers have reported increased incidence of acute motor and sensory axonal neuropathy (AMSAN) and acute inflammatory demyelinating polyneuropathy (AIDP) associated with COVID-19 infection. Both conditions can involve autonomic nervous system dysfunction.¹
Similar Neurologic Findings in Lyme Disease
Neurologic conditions such as acute motor and sensory neuropathy and chronic inflammatory demyelinating polyneuropathy (CIDP) have also been reported in Lyme disease.⁵⁻⁶
Postural orthostatic tachycardia syndrome itself has been described in patients with Lyme disease as well.⁷
Challenges in Diagnosis and Treatment
The authors questioned whether patients with Long-COVID POTS differ from those with POTS unrelated to COVID-19.
POTS has long been known to occur after viral illness. Similar autonomic symptoms have been reported in Lyme disease patients.
The investigators also highlighted a shortage of physicians experienced in diagnosing and treating POTS. Waiting lists for specialists can be six months or longer — a challenge also seen in Lyme disease care.
Treatments for POTS
Several medications have been used to treat POTS symptoms, including:
- Ivabradine
- Midodrine
- Fludrocortisone
Midodrine is a peripheral alpha-adrenergic agonist used for orthostatic hypotension.⁸ Fludrocortisone is a synthetic adrenal steroid that helps expand blood volume.⁹
In some Lyme disease patients, treatment of the underlying infection with antibiotics has improved POTS symptoms.⁷
Questions Addressed in This Podcast
- What is Long COVID?
- What is POTS?
- How is POTS diagnosed?
- What is motor and sensory axonal neuropathy?
- What is inflammatory demyelinating polyneuropathy?
- What is the autonomic nervous system?
- What is Corlanor?
- What treatments are used for POTS?
For a broader overview of the relationship between Long COVID and Lyme disease — including Dr. Cameron’s research involving 889 patients — see Long COVID and Lyme Disease: What Patients Need to Know.
To learn more about how Lyme disease affects the autonomic nervous system, see Autonomic Dysfunction and Lyme Disease.
Thanks for listening to another Inside Lyme Podcast. The advice given here is general and not intended as specific medical advice. Please consult a qualified healthcare professional for individual care.
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
