Investigators continue to struggle with the mysterious occurrence of a bizarre collection of symptoms among adults months after recovering from COVID-19 that prevent them from returning to active lifestyles. Many had mild disease, but still manifest significant disability often referred to as Post COVID Long Haulers. Numerous references point to the similarity of Long Haulers and POTS symptoms. The most commonly reported symptoms of both include extreme fatigue, exercise intolerance, cognitive dysfunction, heart palpitations, memory loss, blurred vision and tinnitus. While the occurrence of post-acute COVID long haulers is still considered a mystery illness by many investigators, diagnosis of the dysautonomia illness POTS is quite easy.

POTS (Postural Orthostatic Tachycardia Syndrome) commonly occurs post-viral illnesses and alters function of the autonomic nervous system that controls many automatic bodily functions, like heart rate and vascular blood flow. The basic physiologic dysfunction in POTS is pooling of blood into the lower extremities when assuming the upright posture. This diminishes the return of blood to the heart; the outcome is the reduction of blood flow to the brain. This brain ischemia (insufficient blood supply of oxygen and nourishment) can produce all of the above described symptoms. In addition, POTS people experience headaches, dizziness, being washed-out, being weak and require more sleep. Symptoms that worsen when upright and improve when lying down strongly suggest the presence of POTS.

Testing for POTS requires a simple TILT TABLE TEST, that measures the heart rate and blood pressure response to gradual tilting 70 degrees (head end-up) from lying flat on a table for 10 minutes.  A positive result for POTS consists of a rise in heart rate of greater than 30 beats per minute (bpm) for adults or pulse greater than 120 bpm without a significant change in blood pressure.  Among adolescents, a 40 bpm rise is required. The rapid heart rate is a compensatory baroreceptor response to the insufficient blood supply to the brain.

Treatment of POTS is primarily behavioral and recovery can be expected:

Avoid and overcome precipitating and aggravating triggers

Correct low blood volume-increase salt and fluid intake

Reverse cardiovascular muscular deconditioning

Reverse lower extremity muscular deconditioning

Establish strengthening and endurance exercise training program

Reduce stress-learn relaxing abdominal breathing

Performing more TILT TABLE TESTS on long haulers with these mysterious symptoms would probably discover more examples of POTS and provide greater opportunities for rehabilitation.