POTS Symptoms After COVID: What This Means for Lyme Disease Patients
HEART RACING AFTER COVID?
DIZZINESS WHEN STANDING?
COULD THIS BE POST-INFECTIOUS POTS?
POTS symptoms after COVID are increasingly reported—and the pattern closely mirrors what many Lyme disease patients have experienced for years.
“I recovered from COVID—but I never felt the same.”
A case series by Blitshteyn and Whitelaw describes 20 patients who developed autonomic dysfunction following COVID-19 infection.
This reflects post-infectious autonomic dysfunction, where infection disrupts the nervous system and leads to persistent symptoms affecting heart rate, circulation, and energy regulation.
Similar patterns have long been observed in Lyme disease, particularly in POTS in Lyme disease, where autonomic dysfunction contributes to dizziness, fatigue, and brain fog.
POTS After Infection Is Not New
Postural orthostatic tachycardia syndrome (POTS) often follows infections such as Epstein–Barr virus, influenza, and Borrelia burgdorferi.
POTS has also been reported after surgery, pregnancy, or concussion—suggesting a broader vulnerability of the autonomic nervous system.
Recognition of POTS after COVID has brought attention to a pattern long observed in Lyme disease: infection can trigger persistent autonomic dysfunction.
The Study: 20 COVID-19 Patients with POTS
Patients were evaluated at a Dysautonomia Clinic and demonstrated orthostatic intolerance on stand testing or tilt-table testing.
Before COVID-19, all patients were functional and employed, with only mild or occasional symptoms in some cases.
After infection, patients developed persistent symptoms including:
- Fatigue
- Postural tachycardia
- Dizziness and orthostatic intolerance
- Exercise intolerance
These symptoms were chronic and often disabling.
Persistent Symptoms at 6–8 Months
Most patients (85%) continued to experience symptoms 6–8 months after infection.
Only three patients fully recovered, while others showed partial improvement with treatment.
Some patients demonstrated markers of autoimmunity or inflammation, suggesting an immune-mediated mechanism affecting multiple systems.
Less common symptoms included neuropathic pain, headaches, chest tightness, and gastrointestinal issues.
Treatment Approaches
Most patients were treated with medications such as beta-blockers, fludrocortisone, midodrine, and ivabradine.
Treatment often also addressed associated symptoms such as headaches, neuropathic pain, and mast cell activation.
What This Means for Lyme Disease Patients
This study highlights a key concept: infection can trigger lasting autonomic dysfunction.
For Lyme disease patients, this pattern is familiar.
Symptoms such as dizziness, fatigue, palpitations, and exercise intolerance often reflect the same underlying mechanism.
Growing recognition of POTS in Long COVID helps validate what Lyme patients have reported for decades.
This is not a new condition—it is newly recognized.
For a full overview, see POTS and Lyme Disease: Why Your Heart Races.
Clinical Takeaway
POTS symptoms after COVID reflect post-infectious autonomic dysfunction.
Similar patterns occur in Lyme disease, where infection disrupts autonomic regulation and leads to persistent symptoms.
Recognition of this pattern improves diagnosis, validation, and treatment.
Frequently Asked Questions
Can COVID-19 cause POTS?
Yes. Patients may develop POTS symptoms following COVID-19 infection, even if previously healthy.
Is POTS after COVID similar to Lyme-related POTS?
Yes. Both involve post-infectious autonomic dysfunction.
Do symptoms improve?
Many patients improve with treatment, though recovery may be gradual.
What treatments are used?
Beta-blockers, fludrocortisone, midodrine, and supportive therapies are commonly used.
Why does this matter for Lyme disease?
It confirms that infections can trigger persistent autonomic dysfunction, supporting patterns long observed in Lyme disease.
Related Reading
- POTS and Lyme Disease
- What Is POTS?
- POTS in Lyme Disease
- POTS and Brain Fog
- Long COVID and Lyme Disease
- Autonomic Dysfunction
References
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Blitshteyn S, Whitelaw S.
POTS and other autonomic disorders after COVID-19 infection
. Immunology Research. 2021.
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
