Post-COVID Long Haulers Are Developing POTS

Most viral infections leave individuals washed out with weakness, fatigue and increased need for more sleep. The more severe the viral illness, the more likely the post-viral symptoms can be troublesome. With COVID infections now rampant, many adults endure varying levels of severity of symptoms. But, thousands of COVID patients are experiencing a strange collection of disabling post-COVID symptoms that prevent them from returning to their pre-COVID active lifestyles. These incapacitating symptoms occur weeks to months after the onset of COVID-19, even though the virus is no longer detectable in the body. This growing group of incapacitated post-COVID patients with an assortment of unexplainable symptoms that refuse to go away are being called “COVID-19 Long Haulers.”

COVID-19 Long Haulers are reporting that in months following improvement from even a mild acute COVID illness, they have developed a chronic debilitating condition linked to prior COVID illness. Long Hauler’s symptoms include: chronic fatigue, brain fog, memory loss, chest pains, shortness of breath, exercise intolerance, insomnia and when upright headaches, racing heart, visual disturbances, dizziness and lightheadedness. Frequently these symptoms are attributed to the preceding viral infection. Medical centers are struggling to determine the cause and possible treatment for these Long Haulers. However, it’s also possible that some of the cases of apparent post-viral fatigue are actually caused by POTS. POTS is also known to frequently begin following an infection or viral infection. Mild undetected POTS may have existed prior to the COVID infection, and the overt POTS symptoms (fatigue, headaches, rapid heart, visual and abdominal symptoms) may have only become more prominent following the COVID illness.

Most of these post-COVID symptoms are identical to those associated with POTS (postural orthostatic tachycardia syndrome). POTS refers to a common medical condition that is rarely recognized even by well-trained and experienced physicians. Postural (relates to posture), orthostatic (relates to being upright), tachycardia (relates to rapid heart rate) and syndrome (relates to a collection of symptoms). POTS is not a disease. POTS is a recognized chronic medical condition identified with increasing frequency among otherwise healthy-appearing adolescents and young adults, especially females. It has been estimated that as many as 3 million young Americans share the symptoms of this curious condition. Most cases go unrecognized and undiagnosed. Even though symptoms most frequently start around adolescence, they can be present for decades before the diagnosis is recognized.

POTS is characterized by rapid heartbeat when standing upright. The primary symptom complex consists of orthostatic (standing upright) intolerance – the body’s difficulty adjusting to the upright position. Rapid heart rate occurs upon assuming an upright posture or standing position and slowly reverses when sitting or reclining. When considering the presence of POTS, dehydration, medications and many debilitating diseases need to be excluded, as their symptoms can mimic POTS.

All symptoms of POTS are related to an excessive gravitational shifting of blood from the upper to the lower body – decreased refilling of the heart – decreased cardiac output – and brain survival protective sympathetic nervous system over-activity (speeding up the heart rate). Among the most common symptoms are a racing heart, fatigue, headaches, light-headedness, dizziness, brain fog, exercise intolerance, eye and abdominal disturbances. Symptoms may be constant or vary from day to day or week to week.

POTS is best recognized by the absolute heart rate rising by greater than 30 beats per minute (BPM) or exceeding 120 BPM without a fall in blood pressure within 8 to 10 minutes of going from the supine (lying flat) position to an orthostatic (upright or head-up) posture in the absence of another chronic disorder. Typically, the rise in heart rate occurs within the first 2 minutes of assuming an upright position. While fatigue, lightheadedness and feeling faint are common components, low blood pressure (hypotension) is not a common finding characteristic of POTS.

Adolescents and young adults who demonstrate symptoms suggestive of POTS following a mild viral illness, should be evaluated for POTS. A number of such POTS cases have been recognized recently following a relatively insignificant Covid-19 infection.

Speaking to the University of Virginia School of Medicine on November 19, 2020, Dr. Anthony Fauci revealed alarm over some coronavirus survivors (25-35%) who are experiencing prolonged serious incapacitating symptoms weeks or months later. Known as COVID- Long Haulers, they report: severe fatigue, tachycardia, headaches, inability to focus or concentrate and autonomic dysfunction (failure of several automatic bodily functions): https://www.yahoo.com/lifestyle/dr-fauci-warns-covid-syndrome-175841678.html Automatic processes are responsible for maintaining circulation of blood upward against gravity while upright. Investigators at Autonomic medical centers are beginning to recognize the association of many post-COVID-19 illnesses with POTS: https://www.wate.com/health/coronavirus/covid-19-long-haulers-are-developing-debilitating-chronic-condition-called-pots/

Adolescents and young adults need to be on the look-out for the occurrence of fatigue, headaches, rapid heart, visual and abdominal symptoms following any viral-like illness, with worsening of symptoms when upright and improvement when lying down. This group of symptoms strongly suggests the presence of POTS and requires appropriate medical evaluation.

Whereas routine clinical and laboratory testing of post-viral illness patients fail to provide clues to the diagnosis of POTS, physicians rarely consider POTS in their differential diagnosis. Autonomic dysfunction, (poor control of automatic bodily functions) commonly observed after viral infections, may be manifested by pooling of blood into the lower body when upright. Inability to pump blood upward back to the heart compromises blood flow directed up to the brain. Reduced brain blood circulation can be responsible for practically ALL symptoms observed among POTS subjects. Tilt Table Testing is the GOLD STANDARD TEST for diagnosing POTS, but is rarely considered or performed. In the presence of POTS, tilting induces pooling of blood into the lower body and reflex tachycardia follows as the body automatically attempts to protect the brain from insufficient oxygen and nourishment.

The keys to POTS recovery are learning how to avoid and overcome triggers, correcting low blood volume by increasing salt and fluid intake and reversing cardiovascular and lower extremity muscular deconditioning by establishing a strengthening and endurance exercise training program.

Dr. Scheldon Kress is a specialist in Internal Medicine with over 30 years of clinical experience caring for patients and pioneering behavioral management strategies to help patients make healthy lifestyle changes with respect to weight loss, stress management, diabetes management and smoking cessation. Passionate about helping patients manage difficult to diagnose medical conditions, he became interested in POTS when several family members and friends struggled with the symptoms, proper diagnosis and effective management of POTS.

Observing the challenges of POTS first-hand, he began to provide POTS patients and their families with a better understanding of causes and potential treatments, while at the same time teaching them how to utilize an effective behavioral change program to manage their POTS symptoms. This self-directed program is a must-read for patients and families dealing with POTS to empower them to take back their lives and achieve POWER over POTS.

Five Star Reviews

Extremely helpful and informative

My daughter has been suffering these symptoms for months. She, like many others, has been misdiagnosed with neurological diseases and mental illness. Even with her heart rate being 30 beats different and multitude of symptoms, doctor was still skeptical because of her blood pressure not changing. Doctors are not educated on this syndrome and it’s extremely hard to find one that is. This has brought a lot of stress to our family, however, as her mom, I persevered, held my own and kept on researching. I came across POTS, educated myself and now we know what’s wrong and how to fix it. This book was one of the books to help us get there. Thank you for publishing this extremely helpful information!

- Praha2014, Amazon

I would like to thank Dr. Kress for writing this book and bringing much needed attention to this illness. POTS is something I have struggled with for many years and I appreciate how thorough and descriptive the book is. The first part of the book expertly describes the ins and outs of finding a diagnosis and how to recognize POTS in a patient. The second section of the book is perfect for families trying to navigate the lifestyle changes that a patient and the rest of the family go through in order to make recovery easier. The book covers all the bases for someone who is looking for more information about POTS. I will most definitely be sharing this book with friends and family and continue spreading the word of this most amazing book.

- Mary Beth, Amazon

The Best POTS Book Available!

This book was extremely helpful in helping my family understand and navigate POTS. The medical information is outstanding and the explanations for the behavioral changes necessary to improve POTS symptoms are easy to understand. I would recommend this book to anyone who is interested in learning more about POTS or wants to lessen their POTS symptoms to feel better. It really is a fantastic book and I like that it is written by a medical doctor who really understands how POTS affects every aspect of a patient's life.

- Angelina, Amazon

This book was incredibly helpful in educating me and helping me manage my child's difficult medical condition.

- Karen, Goodreads

Additional Information

I hope you find my book to provide helpful information on the subjects discussed. The book is not meant to be used, nor should it be used, to diagnose or treat any medical condition. For diagnosis or treatment of any medical problem, consult your own physician. The publisher and author are not responsible for any specific health needs that may require medical supervision and are not liable for any damages or negative consequences from any treatment, action, application or preparation, to any person reading or following the information in this book. References are provided for informational purposes only and do not constitute endorsement of any websites or other sources. Readers should be aware that the websites listed in this book may change. The author is no longer in private practice and not in a position to respond to any medical inquiries.