What is POTS and why is it more common now?

Cases of postural orthostatic tachycardia syndrome (POTS) have increased since the pandemic. The condition is mostly found in women and can be debilitating, affecting people who were seemingly healthy before. It can be exacerbated by a viral infection like Covid-19 and does not have a cure. 

What is POTS?

POTS is a "condition that causes a number of symptoms when you transition from lying down to standing up, such as a fast heart rate, dizziness and fatigue," said the Cleveland Clinic. "If you have POTS, your body can't coordinate the balancing act of blood vessel constriction (squeezing) and heart rate response," which means that "your body can't keep your blood pressure steady and stable." The condition affected between one and three million people prior to 2020. Now, research suggests that anywhere from 2% to 14% of people who are infected by Covid-19 may develop POTS. "The most common trigger of POTS is a viral infection," Svetlana Blitshteyn, a neurologist and the director of the Dysautonomia Clinic in Buffalo, New York, said to CBS News. "This includes viruses like influenza and parvovirus and Covid-19."

There has been a recent slew of diagnoses in teens and adults who were otherwise healthy. Specifically, highly-trained female athletes have been affected. "These patients are young people in their 20s, 30s and 40s who were healthy or had minor medical problems that didn't impact their lives before and now they are expressing extreme fatigue, dizziness, headache, inability to exercise and some are unable to work," Blitshteyn said. However, doctors are not quick to diagnose POTS. "Since POTS isn't technically life-threatening, if you're fatigued or fainting, have a racing heartbeat, a doc will likely scan you for other, perhaps more immediately dangerous, things before considering POTS," said Self.

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Who is most affected?

POTS is largely found in women, but "it's not a lock-and-key situation with just anybody getting Covid and then POTS," Camden Hebson, a pediatric cardiologist, said to The Washington Post. "It's that some patients had a predisposition to POTS to begin with, and then something comes along — it could be mono or covid or something else to give them a push." Women are also thought to be "more vulnerable to inflammation," said the Post. "It could reflect the damage that comes with being hit with a virus unknown to humans until 2020. And the stress associated with repetitive physical exhaustion could leave athletes at risk." 

Athletes may be predisposed to the condition. Some of those diagnosed also had hypermobility, meaning they have a greater-than-average range of motion, which is beneficial in a number of sports. But hypermobility could also be making blood vessels "more stretchy," impacting heart rate and blood pressure, Sara Gould, an orthopedic surgeon, said to the Post. In addition, some POTS patients also have a "condition called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which is characterized by post-exertional malaise (PEM) — a situation in which symptoms worsen after exercise," said National Geographic. 

POTS has no cure, but steps can be taken to reduce symptoms, including exercise, diet changes, sleep changes, and in some cases, medication. "While POTS isn't life-threatening, it can greatly interfere with daily living and tasks," said Cleveland Clinic. "The good news is that a variety of treatments and strategies can help improve symptoms."