Orthostatic tachycardia after covid-19

Previous studies have found that 25% of long Covid patients may have dysautonomia and 2-14% will develop postural orthostatic tachycardia syndrome (PoTS). Here is a summary of when PoTS should be suspected, how it should be diagnosed, and ways in which it can be managed.  

When considering dysautonomia as a cause of tachycardia, practitioners should first carefully access red flag symptoms for other cardiac pathologies. Symptoms of PoTS could include palpitations, fatigue, and breathlessness upon standing or with minimal exertion. Investigations, like blood tests (full blood count, renal and kidney function, C reactive protein, vitamin B12, folate, ferritin, thyroid function, glucose, calcium, and morning cortisol), chest x ray imaging, ECG, and 24 hour ambulatory blood pressure and heart rate monitoring, are aimed at excluding other differential diagnoses 

Though evidence on long-covid is limited, treatment options in the first instance should include reassurance and non-pharmacological methods. For example, adequate fluid intake, avoidance of triggers (alcohol, caffeine etc.), waist-high compression hosiery and physical reconditioning. Drugs aimed at controlling heart rate and increasing peripheral vasoconstriction and intravascular volume can be tried if conservative treatment fails...Read more