Dizziness Upon Standing Linked to COVID-19

Highlights :

POTS emerging as 'long-haul' symptom months after COVID-19 infection
Postural orthostatic tachycardia syndrome (POTS) symptoms include rapid heart rate, dizziness upon standing, light-headedness, headache, and palpitations
Viral illnesses, severe infections, or traumas are usually followed by POTS in 30% to 50% of patients.

Even months after recovering from COVID-19 infection, patients can experience long term symptoms that are consistent with a diagnosis of postural orthostatic tachycardia syndrome (POTS), according to a clinical case report.

Postural Orthostatic Tachycardia Syndrome (POTS)

Postural Orthostatic Tachycardia Syndrome (POTS) is a circulatory disorder which is characterized by an increase in heart rate or tachycardia. POTS condition is most commonly known for causing dizziness upon standing, other symptoms include light-headedness, headache, palpitations, fatigue, blurred vision, brain fog, nausea, and exercise intolerance.

POTS usually affects young and middle-aged women. What causes POTS is yet to be known, but it usually follows a viral illness, severe infection, or trauma in 30% to 50% of patients. POTS can be treated with medications (ivabradine (Corlanor), and beta-blockers), diet (increased fluid intake), exercise, and lifestyle changes.

COVID-19 Infection and POTS

The case report discusses three Swedish patients, two women and one man, who got diagnosed with POTS over three months after they were suspected of having COVID-19 infections. In 2020, all three of them experienced symptoms similar to the COVID-19 infection, but not all of them sought medical attention or received COVID-19 tests at the time of their symptoms.

The first patient tested negative for COVID-19 on a nasopharyngeal swab test but later on had borderline results on serology tests for the virus.
The second patient was confirmed to have COVID-19 early on PCR testing.
While the third patient tested negative for coronavirus repeatedly, they were still referred to a tertiary center for post-COVID-19 follow-up.

Later that year, all three began experiencing symptoms suggestive of POTS and the diagnosis was confirmed using Valsalva maneuver, active standing, and head-up tilt tests.

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‘Half of long COVID sufferers may actually have POTS syndrome. POTS symptoms include rapid heart rate, dizziness upon standing, light-headedness, headache, fatigue, and blurred vision.’
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Madeleine Johansson, lead co-author, said, "As reports of COVID-19 patients being impacted by long-term symptoms unrelated to their original diagnosis continue to grow, it's important to raise awareness of POTS as a possible long-term complication."

She adds, "Much remains unknown about the specific mechanisms responsible for the POTS-like symptoms in post-COVID-19 patients or how long these symptoms will last, but chronic symptoms are expected in a subset of patients based on this initial clinical experience."

The researchers stress that a negative COVID-19 test does not mean that the patient has never been infected with COVID-19. These tests need to be interpreted with caution in the context of typical symptoms, and other causes of POTS symptoms like, hyperthyroidism, cardiac disease, anxiety, anemia, metabolic disorders, chronic fatigue syndrome, or deconditioning.

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Satish Raj, MD, who was not involved in the study, commented, "This article from Sweden documents what many autonomic clinics are starting to see, which is an increase in referrals for patients with POTS late post-COVID. The full impact of long COVID and long COVID POTS is not yet known. With over 117 million patients who have suffered from COVID-19, we may be seeing many similar patients."

He adds that this report highlights the importance of assessing orthostatic vital signs with a stand test, which can be done in any doctor's office, or even in a patient's home using an automatic blood pressure monitor.

Pam Taub, MD, also commented, “It is important for clinicians to recognize that POTS can present as a manifestation of post-acute sequelae of SARS-CoV-2 infection, given that there are many treatment options for POTS and a delay in diagnosis leads to further physical deconditioning and poor quality of life.”

However, David Benditt, MD, questions if this should be labeled as POTS. “It is certainly likely a form of autonomic disturbance that needs more study in terms of its prevalence, cause (e.g., antibodies, neuro humoral agents, virus directly etc.) and ultimate prognosis. Labeling these patients as 'POTS' further confuses an already confused landscape,” he adds.

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He suggests that a clinical investigation should focus on establishing a more specific diagnosis, and not to assume that all triggers of a 'POTS-like' picture will have the same outcome or respond to the same treatments.

Reference :

Long-Haul Post–COVID-19 Symptoms Presenting as a Variant of Postural Orthostatic Tachycardia Syndrome: The Swedish Experience: Madeleine Johansson et al: J Am CollCardiol Case Rep. Mar 10, 2021: DOI: 10.1016/j.jaccas.2021.01.009

Source-Medindia