POTS Symptoms in COVID-19 Patients

POTS symptoms after COVID-19 are increasingly reported, and the pattern mirrors what many 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

Postural orthostatic tachycardia syndrome (POTS) often occurs after viral or bacterial infections, including Epstein–Barr virus, influenza, and Borrelia burgdorferi — the bacterium responsible for Lyme disease. POTS has also been reported following surgery, pregnancy, or concussion.

Recognition of POTS symptoms in COVID-19 patients has brought renewed attention to a pattern Lyme disease clinicians have observed for years: infection can trigger persistent autonomic dysfunction long after the initial illness resolves.

The Study: 20 COVID-19 Patients with POTS

The patients were evaluated at a Dysautonomia Clinic and demonstrated orthostatic intolerance on either a 10-minute stand test or tilt-table testing.

Of the 20 participants, six had mild pre-existing autonomic symptoms such as occasional dizziness, syncope, or palpitations. However, prior to COVID-19 infection none had chronic orthostatic intolerance and all were fully functional and employed.

After recovery from COVID-19, most patients experienced persistent symptoms including fatigue, postural tachycardia, orthostatic intolerance, dizziness, and exercise intolerance. These symptoms were chronic and often disabling.

Persistent Symptoms at 6–8 Months

Most patients (85%) reported persistent symptoms 6–8 months after their COVID-19 infection, although many noted improvement with treatment. Only three patients fully recovered during the follow-up period. Eight were able to return to part-time or full-time work.

Six patients showed mild abnormalities on cardiac or pulmonary testing. Four patients demonstrated elevated markers of autoimmunity or inflammation, suggesting a possible immune-mediated mechanism affecting neurologic, cardiopulmonary, 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 twenty patients (80%) were treated with pharmacologic therapy including beta-blockers, fludrocortisone, midodrine, ivabradine, and medications for comorbid conditions such as headaches, neuropathic pain, or allergic symptoms related to mast cell activation.

What This Means for Lyme Disease Patients

The authors concluded that POTS and other autonomic disorders may develop after COVID-19 infection even in previously healthy individuals who were not hospitalized.

This observation is important for Lyme disease patients because the mechanism appears similar: infection triggers autonomic nervous system dysfunction that persists after the acute illness.

Growing recognition of POTS in Long COVID may help validate the autonomic symptoms Lyme patients have reported for decades.

For a comprehensive overview of the connection between Lyme disease and POTS, see POTS and Lyme Disease: Why Your Heart Races.

Frequently Asked Questions

Can COVID-19 cause POTS?

Yes. In this case series, previously healthy individuals developed POTS symptoms following COVID-19 infection, and 85% still had symptoms 6–8 months later.

Is POTS after COVID-19 similar to POTS after Lyme disease?

Yes. Both conditions involve post-infectious autonomic dysfunction. Infection appears to trigger persistent dysregulation of the autonomic nervous system.

Do POTS symptoms after COVID-19 improve?

Many patients improved with treatment, but only three of twenty fully recovered during the study follow-up period.

What treatments were used for post-COVID POTS?

Patients were treated with beta-blockers, fludrocortisone, midodrine, ivabradine, and medications targeting headaches, neuropathic pain, or mast cell activation symptoms.

Why does this study matter for Lyme disease patients?

Recognition of autonomic dysfunction in Long COVID supports what Lyme disease patients have long reported: infections can trigger measurable, persistent autonomic nervous system disorders.

References

Blitshteyn S, Whitelaw S.

Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after COVID-19 infection: a case series of 20 patients
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Immunology Research. 2021;69(2):205-211.

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