POTS & COVID-19: What Are Your Risks?

by | Feb 23, 2023 | Blog, General Wellness, Mental Health

The COVID-19 pandemic has brought us a list of unexpected health challenges. One of these health complications is Postural Orthostatic Tachycardia Syndrome (POTS). Research suggests there is an increased risk of developing POTS after COVID-19 infection. There is also some chance of developing POTS from vaccines. Knowing this, how can you best protect your health?

In this article, I will discuss the potential link between POTS, COVID-19, and vaccines. You will understand where current research stands and what your risks are of developing POTS. I will also share some recommendations to support your health if you have POTS.

What Is COVID-19

I don’t have to introduce you to COVID-19. It’s an infectious disease caused by the SARS-CoV-2 virus. Since March 11, 2020, when the World Health Organization (WHO) declared a global pandemic, hundreds of millions have been infected, and several million people have died related to the infection (1). 

COVID-19 can lead to mild to moderate respiratory illness. Symptoms may include coughing, fatigue, fever, loss of taste or smell, respiratory symptoms, and other issues. People who are older or have underlying medical issues, such as chronic respiratory disease, diabetes, cardiovascular diseases, or are immunocompromised are at higher risk of severe illness, hospitalization, complication, and death.

COVID-19 is here to stay, but we have better strategies to reduce our risks and improve our recovery. Research is ongoing to learn more about the infection, risk factors, health consequences, and treatment strategies. 

Despite increased research and understanding, a large number of people are still experiencing long-term issues after recovering from their initial infection.

What Is Long Hauler Syndrome

Long hauler syndrome is also known as long haul syndrome, long hauler COVID, long COVID, long-term COVID, long haul COVID, and post-COVID syndrome. It refers to a condition when people are still experiencing long-term symptoms and ongoing health issues weeks, months, or even a year after recovering from an initial COVID-19 infection. 

People experiencing symptoms of long hauler syndrome are often called ‘long haulers’ or ‘COVID-19 long haulers’. Some may experience only one or a few milder symptoms. Others experience a list of health issues that may be severe and seriously interfere with their lives (2, 3).

According to the Public Health Agency of Canada, about 60% of people experienced persistent symptoms for up to 12 weeks and 60% for longer than 12 after the infection or longer. About 10% of people with long hauler syndrome reported that they were unable to return to work (2). 

Though reports suggest over 100 possible symptoms and health issues connected to long hauler syndrome, common complaints include (2, 4):

  • Fatigue
  • Sleep problems
  • Brain fog, trouble concentrating, and decreased memory
  • Joint pain or muscle pain
  • Shortness of breath or ongoing cough
  • Loss of smell and/or loss of taste
  • Hair loss and rashes
  • General pain and discomfort
  • Anxiety, depression, and post-traumatic stress related to dealing with health issues

When talking about COVID-19 or long hauler syndrome, POTS is rarely the first thing people mention. Yet, increasing evidence and clinical experience suggest that POTS may not only be a risk factor for severe COVID-19 symptoms, but COVID-19 infections and COVID-19 vaccinations may both increase your risk of developing POTS.

What Is POTS?

Postural orthostatic tachycardia syndrome (POTS) affects about 1 to 3 million people in the United States, about 50,000 in Canada, and a lot more around the world. This does not include undiagnosed cases (5, 6).

POTS is a type of dysautonomia, which is an umbrella term for medical issues that affect your autonomic nervous system (ANS). Your ANS controls your body’s automatic functions, including your breathing, temperature regulation, heart rate, blood pressure, digestion, and other areas. Symptoms tend to affect these bodily functions.

POTS is a form of orthostatic intolerance (OI), which is characterized by an abnormally rapid heart rate (excessive tachycardia) and other sudden symptoms when standing up. In OI, when you stand up, the blood that returns to your heart is extremely low in volume, which can lead to a very rapid heartbeat, lightheadedness, and fainting. Lying down tends to improve the symptoms (5, 7, 8, 9).

Risk Factors and Causes of POTS

POTS may affect people of all ages across all genders. However, it mostly affects females during their reproductive years. About 75 – 80% of people with POTS are females between the ages 15 and 50 (5, 7, 8, 9).

The risk factors for and causes of POTS are not completely understood. Research is ongoing. In some people, it seems to be an inherited condition. In others, it may be connected to prolonged inflammatory reactions, a degenerative disease, an injury, or another disease. In many people, symptoms first begin after pregnancy, a viral illness, major surgery, or trauma (5, 7, 10, 11, 12). 

Gut microbiome imbalance, mast cell activation, and mold may also play a role in the condition (13, 14, 15). You may learn more about the potential causes and diagnosis of POTS in this article.

In the next sections, you will learn how a specific viral infection, COVID-19 may increase your risk and symptoms.

Symptoms of POTS

Symptoms of POTS may include:

  • Increased heart rate (30 beats/minute above resting heart rate; an increase to 120 or over when standing)
  • Fainting
  • Dizziness
  • Fatigue
  • Weakness
  • Shaking
  • Sweating
  • Bloating, cramping, diarrhea, and other gastrointestinal issues
  • Sleep difficulties
  • Shortness of breath

POTS as a Post-COVID Issue

A 2021 case study published in Clinical Autonomic Research has found that autonomic dysfunction was a common issue observed in participants after recovering from COVID-19 (16). About 93% of patients experienced lightheadedness, 36% had abnormal sudomotor function (controlling the activity of sweat glands), 27% poor cardiovagal function, and 22% reported orthostatic headaches, among other issues. 41% of patients experienced orthostatic symptoms without tachycardia. 22% met the diagnostic criteria for POTS and 11% were on the borderline criteria of OI.

A 2022 review published in Heart Rhythm has found that anywhere between 4 and 14% of people develop POTS after recovering from COVID-19 (17). An additional 9 to 61% experience POTS-like symptoms, including tachycardia, OI, cognitive impairment, and fatigue within the first 6 to 8 months after recovering from the initial infection.

But why is it happening? Great question. Research is still ongoing on the topic, and we still don’t fully understand why some long haulers experience POTS and POTS-like symptoms. We also don’t completely understand how long hauler POTS may be different from POTS developing after a concussion or other health event. However, there is some research evidence that offers some great potential answers to long hauler POTS.

According to current research evidence, you may develop long hauler POTS because of the potential combination of the following issues:

  • Direct effect: Research, including a 2021 study published in Frontiers in Neurosciences, suggests that the virus may attack certain areas of your brain (18). This includes areas where the ACE2 receptor is found, including your hypothalamus, brainstem, and pituitary gland, which all play a role in automatic responses. By impacting your brain health, COVID-19 may increase your risk of symptoms of dysautonomia.
  • Increased immune response: Your initial infection can lead to a cytokine storm and an uncontrolled immune response (19). According to a 2014 review published in Comprehensive Physiology, experiencing a cytokine storm can seriously impact the ANS (20). It’s not surprising that a COVID-19-related cytokine storm may increase the risk of dysautonomias.
  • Neurovascular coupling dysfunction: Neurovascular coupling is a mechanism that ‘links transient neural activity to the subsequent change in cerebral flow’ (21). It’s critical for neural and brain activities. According to a 2020 review published in SN Clinical Comprehensive Clinical Medicine and a 2020 review published in Frontiers in Cellular Neurosciences, COVID-19 may increase the risk of neurovascular coupling dysfunction and brain neurotropism (22, 23). This may affect ANS dysfunction and explain POTS-like symptoms post-infection.
  • Pandemic-related stress: Chronic stress and anxiety can seriously impact your physical body too. According to a 2015 study published in PLoS One, chronic stress can seriously impact your ANS (24). It wouldn’t be surprising that pandemic-related stress may add to the other problems and contribute to dysautonomia symptoms.
  • Long periods of rest: Long hauler syndrome and post-infection POTS don’t only impact those who had a severe illness during the infection, but also those with mild infection. However, in those who experience severe illness and possibly be on bed rest or spend weeks in the hospital, prolonged periods of lying down may play a role in their new POTS-like symptoms. According to a 2019 study published in Frontiers in Physiology, 21 days of bed rest may trigger some symptoms of OI even in otherwise healthy individuals (25).

The Risk of Getting POTS After COVID-19 vs After Vaccination

Let me start by saying that vaccines currently present one of the best options for reducing risk of mortality, hospitalization, and severe illness associated with infectious pathogens for most individuals. The Public Health Agency of Canada and the Centers for Disease Control and Prevention both recommend getting vaccinated to reduce your risks of infection and severe outcomes (26, 27). 

That being said, getting vaccinated does carry some small risks. A 2022 case report published in Clinical Autonomic Research discussed the case of 5 patients with POTS-like symptoms after receiving their mRNA COVID-19 vaccine (28). This is a very small sample. However, it still suggests that there may be a small risk of POTS-like symptoms after getting vaccinated. 

You may feel confused. Getting COVID-19 may increase your risk of POTS. So does the vaccine. How are your risks of getting POTS after the vaccines compared to developing POTS after a COVID-19 infection? 

A 2022 study published in Nature Cardiovascular Research has found that the risk of getting POTS after a COVID-19 infection is five times higher than getting it from the vaccine (29, 30). The study look at 284,592 vaccinated individuals “(age 52 ± 20 years; 57% female; 63% White, 10% Asian, 8.9% African American and 12% Hispanic)” (30). Most individuals received the Pfizer-BioNTech vaccine at 62%. 31% received the Moderna vaccine, 6.9% Johnson & Johnson/Janssen, and <0.1% other vaccines, such as AstraZeneca, Sinovac, and Novavax.

Using a sequence-symmetry analysis, they looked at the risk of getting a diagnosis of POTS or associated issues after getting vaccines, before exposure to COVID-19, and post-infection. They found there was a greater chance of experiencing POTS-like symptoms after getting vaccinated compared to experiencing any other common health complaints or primary care diagnoses. Meaning, there is a much greater risk of experiencing POTS post-vaccination than developing fatigue, headaches, eczema, edema, UTIs, hyperlipidemia, mast cell issues, GERD, diabetes, lumbago, or other issues. However, they still found a greater risk of developing myocarditis, and a stronger link between myocarditis and vaccination, than between POTS and vaccines. 

When looking at the potential connection between POTS and COVID-19, they looked at 12,460 cases “(age 47 ± 23 years; 50% female; 54% White, 6% Asian and 20% African American and 29% Hispanic ethnicity)” (30). They found that getting COVID-19 presented a great risk of developing both POTS and POTS-like problems and also common primary care diagnoses (as listed earlier) compared to vaccination. The risk of developing POTS post-infection, however, was also higher than developing the other health complaints they looked at. 

While we discussed how COVID-19 might cause damage to the ANS, leading to POTS, it is not clear how vaccination might increase the risk of POTS. Researchers stated it may be the result of an inflammatory reaction to the spike protein from the mRNA vaccines. However, at this point, this is all speculation. We need more research to better understand the connection between vaccines and POTS, and COVID-19 infections and POTS. 

It’s also worth noting that the study had some limitations. Traditional diagnostic criteria for POTS require for the symptoms to occur for at least 90 days. Since the study didn’t follow up on individuals later, we don’t know if their symptoms improved or not. Their POTS-like symptoms may only be temporary. Thus, it’s possible that the study overestimated the diagnosis of POTS and POTS-related issues. Still, one thing is clear. There are some risks of POTS with both infections and vaccinations. We need more research to understand the complete picture.

Most importantly, researchers found that the chance of developing POTS from vaccination is significantly lower than developing POTS from a COVID-19 infection. Vaccines also reduce overall risk of getting infected, developing severe symptoms, hospitalization, mortality, and long-term consequences.

Recommendation for POTS and COVID-19

If you are experiencing symptoms of POTS, I recommend the following strategies:

  • Move your body regularly
  • Increase your fluid and salt intake
  • Follow a fiber-rich, nutrient-dense diet
  • Try a compressive device
  • Get enough sleep

You may learn more about these strategies to improve your health with POTS by reading this article

If you are experiencing any symptoms of long hauler syndrome and want to improve your health, check out my recommendations here and here. I also recommend checking out my tips for post-pandemic wellness here to improve your immune health and overall wellness.

Next Steps

If you are experiencing symptoms of POTS or symptoms of long hauler syndrome, I invite you to schedule a consultation with me here

If you are dealing with any chronic health issues, I welcome you to start a functional medicine consultation with me for further personalized guidance. You may book your consultation here

Check out my Histamine Intolerance Course here. Learn on your own time, from anywhere. Get an inside look at the most helpful functional medicine tests for pinpointing imbalances, ways to identify and manage the most common (and sometimes surprising) mast cell triggers, and learn what to eat, what to avoid, and why.

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