Postural orthostatic tachycardia syndrome, or POTS, was a little-known condition before the pandemic. Since then, it’s received far more attention, partly because many people with long COVID develop POTS-like symptoms. A study published in Nature Cardiovascular Research looked at how often POTS shows up after COVID-19 infection and after COVID-19 vaccination, and found a link to both, with a stronger link after infection.
What is POTS?
POTS is a disorder of the autonomic nervous system, the part of the nervous system that automatically controls heart rate, blood pressure and blood flow. In people with POTS, the heart rate jumps abnormally when they stand up, typically by 30 beats per minute or more within 10 minutes of standing, without a significant drop in blood pressure.
POTS is most common in young women of childbearing age. Symptoms can include:
- Dizziness or lightheadedness when standing
- Fainting or nearly fainting
- A racing or pounding heartbeat
- Fatigue and brain fog
- Headaches, shakiness, sweating and trouble tolerating exercise
For some people, symptoms are mild. For others, POTS can make it hard to work, attend school or stay on their feet for long.
How the study was done
Researchers at the Smidt Heart Institute at Cedars-Sinai in Los Angeles analyzed health records from nearly 285,000 people who received at least one COVID-19 vaccine dose in the Cedars-Sinai system between 2020 and 2022, along with about 12,000 patients who had COVID-19 infection. They compared how often POTS and related symptoms were diagnosed in the 90 days after vaccination or infection with the 90 days before.
What they found
- POTS diagnoses rose after vaccination. The odds of a POTS diagnosis were higher in the 90 days after vaccination than in the 90 days before.
- The increase was larger after infection. The odds of POTS rose more after COVID-19 infection than after vaccination.
- The overall risk after vaccination was small. Lead author Dr. Alan Kwan described the vaccine association as “possible—yet still relatively slim.”
“The main message here is that while we see a potential link between COVID-19 vaccination and POTS, preventing COVID-19 through vaccination is still the best way to reduce your risk of developing POTS,” Kwan said, according to SciTechDaily.
Important limits
The study was observational and relied on diagnoses in medical records, so it can show an association but can’t prove cause and effect. People may also see doctors more often after vaccination or illness, which can lead to more diagnoses, though the researchers said this didn’t fully explain the increase. More research is needed to understand why POTS develops after infection or vaccination in some people.
The researchers also noted that greater awareness of POTS during the pandemic has helped many patients get diagnosed sooner, which allows earlier treatment.
What this means for you
- Don’t dismiss symptoms. If you feel dizzy, faint or have a racing heart when you stand, especially after an illness, tell your doctor.
- Ask about a stand test. A simple test that measures heart rate and blood pressure lying down and standing can help screen for POTS. A tilt-table test may also be used.
- Know that POTS is treatable. Increasing fluids and salt (when advised by a doctor), compression garments, gradual exercise programs and, in some cases, medication can improve symptoms.
- Talk through vaccine questions. If you have concerns, discuss your personal risks and benefits with your provider. The researchers concluded that vaccination remains the best way to lower overall POTS risk.
The bottom line
A large Cedars-Sinai study found that POTS diagnoses rose after both COVID-19 vaccination and COVID-19 infection, with a larger increase after infection. The vaccine-related risk appears small, and POTS can be managed once it’s recognized.
This article is for general information and isn’t medical advice. Talk with your healthcare provider about your individual needs.
