POTS is a form of dysautonomia, a disorder of the autonomic nervous system manifested by an increase in heart rate by a minimum of 30 beats per minute when the body is upright, without a decrease in blood pressure. Symptoms of POTS include:
- Heartworms,
- Dizziness and weakness when changing positions,
- Chronic fatigue,
- Brain fog (problems with concentration and memory),
- Headaches and muscle weakness.
Interestingly, POTS symptoms can appear both during COVID-19 infection and many months later, despite recovery from the acute phase.
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Diagnosis and treatment of POTS in Long COVID
POTS can be diagnosed in the doctor's office, based on orthostatic tests. In inconclusive cases, a tilt-table test is worth considering. Treatment is based on strategies familiar from classic POTS:
- Blood pressure support:
- Salt supplementation and adequate hydration,
- Use of compression stockings to improve venous circulation.
- Physical activity:
- Despite concerns about exhaustion, the 2024 study suggests that graded physical activity does not harm Long COVID patients, and in fact promotes recovery. Moderate-intensity exercise, similar to that recommended for ME/CFS and fibromyalgia, is indicated.
- Pharmacotherapy:
- Propranolol and midodrine effectively relieve orthostatic symptoms,
- Low-dose naltrexone (LDN), increasingly being studied in Long COVID, has shown potential in reducing the neuroinflammatory substrate of dysautonomia, consistent with its efficacy in fibromyalgia.
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Prognosis and challenges
Although in many patients the symptoms of POTS resolve within 12 months, for some people the disorder becomes a cause of severe limitations in daily functioning. Therefore, it is crucial to further investigate the mechanisms of Long COVID and to develop effective therapeutic strategies to speed up recovery.
POTS therapy
Long COVID and its complications, such as POTS, show how complicated the impact of SARS-CoV-2 infection can be on the autonomic and immune systems. POTS therapy requires a holistic approac...
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