POTS, or Postural Orthostatic Tachycardia Syndrome, is a condition characterised by orthostatic intolerance, i.e. the circulation in the body cannot adapt to an upright position. Exactly what induces this disease is difficult to determine. POTS can be triggered by a variety of different conditions, such as viral or bacterial infections, traumatic events, surgical procedures and concussion, but can also occur without any known cause.
All over the world, more and more patients have been seen who, long after their Covid infection, are experiencing symptoms consistent with POTS, known as post-Covid POTS. Patients who have had Covid-19, but did not need hospital treatment, bear witness to severe chronic fatigue, brain fog, high heart rate, nausea and, above all, dizziness and fainting, and when they get up or stand up for a long time.
The study has been published in the Journal of the American College of Cardiology – Case Reports.
- Everyday life can be very difficult for these patients, and for those affected it can in some cases be difficult to go back to work, study or lead a normal home life. Patients are placed on long-term sick leave and their quality of life deteriorates. So it’s extremely important that we find out more about the disease and what mechanisms are behind it, so that we can also propose new treatment strategies, says Madeleine Johansson, one of the lead authors of the case report and a postdoctoral student in Cardiology at Lund University.
Women appear to suffer more often than men from long Covid and POTS, and researchers are seeing a general increase, with more and more individuals experiencing long-term effects of a Covid infection. So far, approximately 50–100 patients in Stockholm have been diagnosed with POTS after a Covid infection, and 20–30 in Malmö and Lund.
- As the number of patients with long-term effects of Covid-19 is constantly increasing, it’s important to also raise awareness of POTS as a possible long-term complication after a Covid infection, and we need to find out more about why this is the case, says Madeleine Johansson, who led the research project together with Artur Fedorowski, an expert in POTS and Associate Professor of Cardiovascular Research – Hypertension at Lund University and senior physician at Skåne University Hospital.
The study is a joint project between researchers at Lund University and Karolinska Institutet. Together, they want to highlight POTS in the hope of being able to make better diagnoses and offer the right treatment, and a partnership like this provides access to more data from patients who exhibit symptoms of post-Covid POTS.
As the number of patients with long-term effects of Covid-19 is constantly increasing, it’s important to also raise awareness of POTS
In this report, the researchers publish a systematic overview of POTS in three patient cases that the researchers have followed since September 2020. One patient at Skåne University Hospital in Malmö and two patients at Karolinska University Hospital in Solna; two women, aged 42 and 28 respectively, and a 37-year-old man. All were diagnosed with POTS and received both medical and non-medical treatment. The patients did not respond very well to their treatment for POTS, treatment that normally works, but all three fell ill just over one year after their Covid infection.
- Some of the patients who have long-term effects after a Covid infection do recover, which gives us hope, and others do not at all. While we would like to emphasise that a negative Covid-19 test does not exclude the possibility that a patient has been infected with Covid-19, we should also interpret symptoms of POTS with a great deal of caution. In order to provide the right treatment, we need to be able to clarify whether the patient is suffering from POTS or another diagnosis, says Artur Fedorowski.
The researchers need additional background data about patients and data to investigate post-Covid POTS and long-term effects of Covid-19, in order to better understand the different medical conditions and how they are interconnected.
- We need to learn more about mechanisms behind them in order to offer more targeted drug treatment. Additional studies with bigger patient bases are needed, which we will soon have together with our research colleagues in Stockholm.