What strange disorder has doubled since COVID?

September 21, 2025 •

4 min read

According to numerous studies, the number of individuals diagnosed with postural orthostatic tachycardia syndrome (POTS) has significantly increased since the start of the pandemic. This article explores why experts believe this strange disorder has doubled since COVID and what it means for public health.

Quick Summary

Postural orthostatic tachycardia syndrome (POTS), a form of dysautonomia, has seen a sharp rise in incidence following the COVID-19 pandemic, likely triggered by the SARS-CoV-2 infection.

Key Points

Post-COVID Trigger: Postural orthostatic tachycardia syndrome (POTS) has seen a dramatic increase in incidence, largely attributed to viral triggers from the COVID-19 pandemic.
Debilitating Symptoms: POTS causes a wide range of symptoms, including dizziness, severe fatigue, brain fog, and a rapid heart rate, which are often exacerbated by standing.
Autonomic Nervous System Dysfunction: The core issue in POTS is a malfunction of the autonomic nervous system's ability to properly regulate blood flow and heart rate in response to positional changes.
Misdiagnosis is Common: Symptoms can be mistaken for anxiety or other conditions, leading to long diagnostic delays; specialized testing like a Tilt-Table Test is required for confirmation.
Treatment Focuses on Management: There is no cure, but lifestyle changes like increased fluid/salt intake, compression garments, and specific exercise programs can significantly improve symptoms.
Hope for the Future: Increased awareness and research spurred by the rise in post-COVID POTS cases are leading to better diagnostic methods and treatment strategies.

Understanding Postural Orthostatic Tachycardia Syndrome (POTS)

POTS is a complex condition affecting the autonomic nervous system, the body’s 'autopilot' that regulates involuntary functions like heart rate, blood pressure, and digestion. In healthy individuals, the nervous system maintains steady blood flow to the brain when changing position, such as standing up. For someone with POTS, this system malfunctions. Upon standing, gravity pulls blood downward, and instead of constricting vessels to maintain blood pressure, the body's response is exaggerated, causing the heart rate to spike significantly. This leaves insufficient blood returning to the heart and brain, triggering a wide array of debilitating symptoms. The condition most often affects women between the ages of 15 and 50, though it can occur in men and younger individuals as well.

The Alarming Link Between POTS and COVID-19

The most prominent cause for the documented increase in POTS is its strong association with COVID-19 infection, particularly within the subset of patients suffering from 'long COVID'. Researchers and clinicians have observed that many people who recover from the initial SARS-CoV-2 infection go on to develop POTS-like symptoms weeks or months later. This post-viral onset is not unique to COVID-19; other viruses like Epstein-Barr and mononucleosis have also been known to trigger POTS. However, the sheer scale and reach of the COVID-19 pandemic have led to an unprecedented increase in POTS cases worldwide.

Potential Mechanisms Behind Post-COVID POTS

While the exact cause is still under investigation, several theories suggest how COVID-19 can lead to POTS:

Autoimmune Response: The virus may trigger an autoimmune reaction, where the body produces antibodies that mistakenly attack parts of the nervous system, including the receptors responsible for regulating blood pressure and heart rate.
Nervous System Damage: Some research suggests SARS-CoV-2 can directly invade parts of the nervous system, potentially damaging the areas that regulate autonomic functions.
Chronic Inflammation: The intense inflammatory response, or 'cytokine storm,' associated with severe COVID-19 can persist long after the infection clears, contributing to chronic sympathetic overstimulation and autonomic dysfunction.
Deconditioning and Hypovolemia: The virus's symptoms, like fever and nausea, along with prolonged periods of inactivity, can lead to dehydration and physical deconditioning, which are known to exacerbate or trigger POTS.

Symptoms of POTS and How They Overlap with Long COVID

POTS and long COVID share a significant number of overlapping symptoms, which often leads to delayed or missed diagnoses. This makes distinguishing between the conditions challenging without specific testing. Common symptoms include:

Cardiovascular: Dizziness or lightheadedness, heart palpitations, fainting or near-fainting, and chest pain.
Neurological: Severe fatigue, brain fog (difficulty concentrating and memory issues), headaches, and tingling in the extremities.
Gastrointestinal: Nausea, bloating, diarrhea, and abdominal discomfort.
General: Exercise intolerance, poor sleep, and excessive sweating.

Diagnosis: The Path to Confirmation

Diagnosing POTS can be a long and frustrating journey, as symptoms are often mistaken for anxiety, dehydration, or other conditions. A definitive diagnosis typically involves a combination of medical history review, symptom tracking, and specialized tests. The gold standard is the Tilt-Table Test, where a patient is tilted from a lying to an upright position while blood pressure and heart rate are monitored. A sustained heart rate increase of 30 bpm or more (40 bpm for adolescents) within 10 minutes, without a significant drop in blood pressure, confirms POTS. An at-home stand test may also be used as an initial screening tool.

Comparing POTS and Other Conditions


Feature	POTS	Anxiety	Other Conditions (Anemia, Thyroid)
Primary Cause	Autonomic Nervous System dysfunction	Psychological, stress-based	Hormonal, nutritional, etc.
Trigger	Upright posture, illness, trauma	Perceived threat, stress, trauma	Underlying illness, medication side effects
Heart Rate	Sustained spike upon standing (often >30 bpm)	Often sudden increase due to panic, not tied to posture	May be persistently fast or slow
Symptom Link	Dizziness, fatigue directly follow positional change	Dizziness, fatigue related to emotional state	General malaise, not specifically postural
Diagnosis	Confirmed via Tilt-Table or Stand Test	Clinical evaluation, psychological assessment	Lab tests (e.g., blood work), imaging

Treatment and Management Strategies

While there is no single cure, POTS is a manageable condition. An individualized treatment plan typically combines lifestyle modifications and, in some cases, medication.

Lifestyle Modifications

Increase Fluid and Sodium Intake: Consuming 2–3 liters of fluid and 8–10 grams of salt daily can help increase blood volume.
Wear Compression Garments: Compression stockings and abdominal binders can prevent blood pooling in the lower body.
Implement Graded Exercise: Begin with seated or recumbent exercises like rowing or swimming before gradually progressing to upright activity.
Elevate the Head of Your Bed: Raising the head of the bed can help prevent symptom flares.
Eat Smaller, Frequent Meals: Large meals can exacerbate symptoms. Eating smaller, more frequent meals can ease digestion and blood flow.

Medications

Fludrocortisone: Helps the body retain salt and increase blood volume.
Beta-Blockers: Work to lower heart rate.
Midodrine: A vasoconstrictor that helps prevent blood pooling.

The Outlook for Individuals with Post-COVID POTS

For many, especially those with post-viral onset, POTS symptoms can improve over time with proper management. However, it can also become a chronic, long-term condition. The influx of post-COVID cases has brought increased attention and research funding to POTS, fostering hope for improved diagnostic tools and more effective treatments in the future. For those struggling, self-advocacy and seeking help from specialists are crucial steps toward managing this challenging and often misunderstood disorder.

For more information on the link between POTS and Long COVID, visit the Dysautonomia International website.

Frequently Asked Questions

The most defining feature of POTS is the sustained, abnormal increase in heart rate that occurs specifically upon standing or transitioning to an upright position. While anxiety can also cause a rapid heart rate, it is not consistently and directly triggered by a change in posture in the same way as POTS.

While the exact mechanism is still being studied, researchers believe COVID-19 can trigger POTS through an autoimmune response, direct viral damage to the nervous system, chronic inflammation, or a combination of these factors. This can disrupt the autonomic nervous system's function.

There is currently no cure for POTS. However, many individuals, especially those with post-viral onset, can see significant improvement or even remission of symptoms with proper management. Treatment focuses on a combination of lifestyle adjustments and, if needed, medication.

Yes. Increasing your intake of fluids (2-3 liters per day) and sodium (8-10 grams per day) is often recommended to help increase blood volume. Eating smaller, more frequent meals can also prevent symptoms from worsening after digestion.

Yes, and it is often a crucial part of treatment. However, it requires a specific, careful approach. Patients are typically advised to start with reclined or seated aerobic exercises (like rowing or recumbent biking) and gradually increase intensity, as upright exercise can initially worsen symptoms.

POTS is often misdiagnosed because its symptoms overlap with many other conditions, including anxiety, chronic fatigue syndrome, and thyroid issues. The diagnostic process can be long and requires specialized testing, such as the Tilt-Table Test, to confirm.

POTS is more common than many people realize. Before the pandemic, it was estimated to affect between 1 and 3 million Americans. The incidence rate has risen dramatically following COVID-19, with some sources reporting a doubling of cases.