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Review
. 2024 Aug 15;60(8):1325.
doi: 10.3390/medicina60081325.

Postural Orthostatic Tachycardia Syndrome Associated with COVID-19: A Narrative Review

Jung-Hyun Park  1 , Somin Park  1 , Na-Hye Kim  1 , Yoonjin Lee  1 , Yoonkyung Chang  2 , Tae-Jin Song  3
Affiliations
Review

Postural Orthostatic Tachycardia Syndrome Associated with COVID-19: A Narrative Review

Jung-Hyun Park et al. Medicina (Kaunas). .

Abstract

Postural orthostatic tachycardia syndrome (POTS) is a complex condition marked by an atypical autonomic response to standing, leading to orthostatic intolerance and significant tachycardia without accompanying hypotension. In recent studies, a considerable number of individuals recovering from COVID-19 have been reported to experience POTS within 6 to 8 months post-infection. Key symptoms of POTS include fatigue, difficulty with orthostatic tolerance, tachycardia, and cognitive challenges. The underlying causes of POTS following COVID-19 remain unknown, with various theories proposed such as renin-angiotensin-aldosterone system (RAAS) dysregulation, hyperadrenergic reaction, and direct viral infection. Healthcare professionals should be vigilant for POTS in patients who have recovered from COVID-19 and are experiencing signs of autonomic dysfunction and use diagnostic procedures such as the tilt-up table test for confirmation. COVID-19-related POTS should be approached with a holistic strategy. Although many patients show improvement with initial non-drug treatments, for subjects who do not respond and exhibit more severe symptoms, medication-based therapies may be necessary. The current understanding of COVID-19-related POTS is limited, underscoring the need for more research to increase knowledge and enhance treatment approaches.

Keywords: COVID-19; direct viral infection; hyperadrenergic reaction; postural orthostatic tachycardia syndrome (POTS); renin–angiotensin–aldosterone system (RAAS) dysregulation; tilt-up table test.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Algorithmic approach to postural orthostatic tachycardia syndrome (POTS) diagnosis [26].
Figure 2
Figure 2
Illustration for brainstem and multi-organ damage via direct viral invasion in COVID-19-related postural tachycardia syndrome [36,37,38,39,40,41,42].
See this image and copyright information in PMC

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