OHIO — A recent study from the University of Toledo uncovered a trend that since COVID-19 there has been a rise in postural orthostatic tachycardia syndrome, known more commonly as POTS, patients being diagnosed.
POTS is a chronic and often debilitating blood circulation disorder, characterized by an inability to regulate blood pressure and heart rate, that scientists and doctors have long believed could be caused by viral infections. One virus in particular that has been positioned as a trigger for the syndrome is the Epstein-Barr virus.
The syndrome is effectively a blood pooling disorder. When people stand up, gravity pulls the blood downward and for most people, the body compensates by tightening blood vessels in the lower half of their body. For those diagnosed with POTS, that constriction does not happen and the blood drains down and reduces the brain’s supply of oxygen.
While the heart beats harder and faster to send more oxygen to the brain, it often cannot catch up with the demand with a limited blood supply coming in. The resulting symptoms can include dizziness, fatigue, fainting, pain, anxiety and brain fog.
The university’s study, published in the European Heart Journal – Quality of Care and Clinical Outcomes, points to the pandemic causing an acceleration in what was once believed to be a rarer condition. Researchers say that many patients who suffer from long COVID may have POTS.
“We’ve suspected for several years now that there is an association between COVID and POTS. I’m seeing this in my own clinic. My waiting list is longer than it has ever been,” said Dr. Blair Grubb, a UToledo Health cardiologist. “Now we have the data to back that up. This study helps give validity and voice to these patients, and it gives us a treatable target.”
Grub has treated and studied POTS for more than 30 years. Alongside colleague, Grub examined data pulled from electronic medical records of over 65 million U.S. patients. Through the data, they compared the incidence and prevalence of POTS before and after the emergence of COVID-19, which showed major differences.
Between Jan. 2018 to March 1, 2020, which are the dates researchers used as the cutoff for the pre-COVID time-period, the study found an estimate of 4.21 new cases per month. Between March 2, 2020 to June 2024, the cases rose to 22.66 new cases per month, a five-fold increase.
Through the study, researchers discovered the incidence rate of POTS was 1.42 per 1 million person-years before COVID and 20.3 cases per 1 million person-years after COVID.
Dharmindra Dulal, fourth-year medical student and the lead author of the study, said the study adds scientific evidence to the relationship between COVID-19 and POTS, which has previously been limited to anecdotal accounts.
“We talk about long COVID,” Dulal said. “That’s a big umbrella and there is a lot of disease underneath it. We can’t just say ‘this patient has long COVID.’ We need to diagnose each condition separately, and I think what’s most valuable about this paper is that we can confidently say POTS is one part of long COVID.”
According to the university, this is not the first time this parallel has appeared from POTS. Following the 1918 influenza pandemic, a physician wrote about confounding cardiovascular symptoms in British soldiers who had served in WWI.
“They had POTS,” Grubb said. “He didn’t call it that, but he’s describing it absolutely perfectly. This is not new. I think viral infections have triggered these events throughout time, it’s just that we put it all together recently. We have a good idea of what’s going on now, whereas in the past they didn’t. And we’re seeing that COVID is really good at causing POTS.”
Researchers said while there is a lack of broad recognition, awareness has grown about the syndrome.
“I think people are starting to recognize POTS more as a disease entity itself, and papers like this only help to raise awareness,” said Dr. Ahmed Maraey, a cardiology fellow in the College of Medicine and Life Sciences and the study’s corresponding author.
Maraey said with awareness comes hope for more effective treatments of POTS in the future.
“If we know there is a disease here, we can do more for it. We can do more clinical trials, we can look for new treatments, we can train more people to be able to manage the disease,” he said. “Once we’ve identified there is a problem, we can better deal with it.”
