Almost two-thirds of people with Long COVID in a small Adelaide study met the diagnostic criteria for postural orthostatic tachycardia syndrome, raising the prospect that the condition may be contributing to symptoms including dizziness, fatigue, brain fog and a racing heart.
Researchers from Adelaide University and the South Australian Health and Medical Research Institute compared 24 people with Long COVID, 24 people diagnosed with POTS and 19 healthy participants. The cross-sectional study was conducted between August 2021 and December 2022.
Participants underwent a 10-minute standing test, 24-hour heart monitoring and blood tests examining inflammatory markers and adrenergic autoantibodies.
Heart rates increased by an average of 46 beats per minute after standing among participants with POTS and by 35 beats per minute among those with Long COVID. The average increase among healthy participants was 13 beats per minute.
Lead researcher Dr Marie-Claire Seeley, from Adelaide University’s Rosemary Bryant AO Research Centre, said the similarities between the groups were notable.
“What’s striking in this study is just how similar the two groups were. Almost two-thirds of the people with Long COVID we studied met the diagnostic criteria for POTS,” Dr Seeley said.
POTS affects the autonomic nervous system, which controls functions including heart rate, breathing and digestion. The condition can cause symptoms that appear unrelated, often making diagnosis difficult. The Australian POTS Foundation estimates about 800,000 Australians are living with it.
Heart rates increased by an average of 46 beats per minute after standing among participants with POTS and by 35 beats per minute among those with Long COVID. The average increase among healthy participants was 13 beats per minute
“For people living with Long COVID, symptoms such as dizziness, fatigue, brain fog and a racing heart can be debilitating. Our findings suggest that in some cases, POTS may be contributing to those symptoms,” Dr Seeley said.
“POTS can be assessed using a relatively simple standing test, so recognising the signs is important. But because its symptoms overlap with other conditions, it can be challenging to diagnose.”
She said the findings could give doctors another possible explanation to consider when assessing patients with persistent symptoms after COVID-19.
“Recognising the overlap between Long COVID and POTS gives clinicians another avenue to investigate it, and identifying POTS earlier could help patients access more targeted treatment and support.”
Blood testing also identified subtle differences in inflammatory markers, suggesting low-grade inflammation may have a role. The researchers did not, however, identify a clear disease-causing mechanism linked to autoantibodies.
The study found both conditions had a marked effect on participants’ working lives. Almost six in 10 people in the Long COVID group had been unable to return to work after their infection. Among those with POTS, 4.2 per cent were engaged in full-time work or education.
“These are conditions that can have an enormous impact on people’s ability to work, socialise and participate in everyday life,” Dr Seeley said.
“Better recognition and earlier diagnosis could make a real difference for people living with debilitating symptoms, helping them access more targeted treatment and support.”
The researchers said the results supported routine assessment for autonomic dysfunction among people with Long COVID. However, the study’s small sample and cross-sectional design mean it identifies an association rather than establishing that Long COVID causes POTS.
The research was published in the Journal of the American Heart Association.
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