Postural Tachycardia an Emerging Concern During COVID-19 Recovery
Case arrangement recommends low adequacy of accessible medicines. The chance of COVID-19 long-haulers encountering indications reminiscent of postural orthostatic tachycardia disorder (POTS) was fortified by a little case arrangement from Sweden.
COVID-19 has brought in a significant number of long-haulers. A small case series in Sweden suggests the possibility of these patients experiencing the symptoms which indicate postural orthostatic tachycardia syndrome (POTS). In the spring of 2020 in Sweden, three young patients who were suspected to be affected with COVID-19, were after 3 months, also diagnosed with POTS. This syndrome was detected in them based on orthostatic tachycardia and chronic symptoms of orthostatic intolerance excluding competing etiologies. This research was reported in a paper published online in JACC: Case Reports and the research team was led by Madeleine Johansson, MD, Ph.D., of Lund University and Skåne University Hospital in Malmö, Sweden.
Johansson’s team stated that when POTS is detected in post COVID-19 patients, most information about specific factors responsible for POTS-like symptoms is not known. Moreover, there is data regarding the period for which these symptoms last but based on initial clinical studies, chronic symptoms are expected in some segments of patients.
Satish Raj, MD, of the University of Calgary in Alberta says “The long-term and complete impact of COVID on POTS in post COVID patients remains unknown. There are nearly 117 million COVID-affected patients and we may not see many similar patients. However, what autonomous clinics are increasingly seeing is an upward trend in referrals for patients affected with POTS after COVID-19. This is also corroborated by the Swedish article.” Dr. Raj was not a researcher in the study but discusses his observations.
Pam Taub, MD, of UC San Diego Health System, California observes that POTS does have many treatment options but if there is a delay in diagnosis, it can cause physical deconditioning and overall poor quality of life for the patient. This is important to realize for clinicians because POTS can be seen as a reflection of post-acute sequelae when infected with SARS-CoV-2.
This Swedish case series is second in line with the case report of a POTS-like scenario after COVID-19. The series lends support to the theory of the syndrome's possible connection to viral infections, believes David Benditt, MD, of the University of Minnesota in Minneapolis.
Johansson and her colleagues noticed that POTS can be brought about by a viral illness or serious infection in 30-50% of the post COVID-19 patients.
In the Swedish case, the three patients were in the age range of 28-42, two of them being women and one man. Flu-like symptoms were common for all three even though the first patient tested negative for COVID-19 through a nasopharyngeal swab test. However, the patient then has borderline results conducted by a serology test for SARS-CoV-2. The second patient was confirmed with COVID-19 early on PCR testing and the third consecutively tested negative. However, the latter was then referred to a tertiary center for a post-COVID-19 check-up.
Constant fatigue, headache, dizziness, palpitations, brain fog, or exercise intolerance during recovery from COVID-19 are some symptoms indicative of POTS. To diagnose the presence of POTS in those three patients, clinicians performed a combination of Valsalva maneuver and active standing and head-up tilt (HUT) tests on the patients.
Dr. Raj pointed out the significance of assessing orthostatic vital signs with a stand test as suggested in this report. This becomes more important in a time when research funders contemplate how to operate the supervision.
Johansson’s team observed that increase in fluid intake, compression stockings, ivabradine (Corlanor), and beta-blockers were recommended for the POTS treatment. While this paper was drafted, all three patients took sick leaves from their workplaces and two of them were still highly symptomatic patients. Mr. Benditt states that “the primary issue with this paper is if they should title it as POTS as putting a label can create further confusion in an already confusing scenario. POTS is most likely a form of autonomic disturbance that needs to be delved deeper into in respect of its prevalence, cause (e.g., antibodies, neurohumoral agents, direct virus, etc.) and ultimate prognosis.”
Johansson and her team note that dehydration, other infections, hyperthyroidism, cardiac disease, anxiety, anemia, metabolic disorders, chronic fatigue syndrome, or deconditioning can be other evident causes of sinus tachycardia. However, for the purposes of a different diagnosis of POTS, it is imperative to exclude these.
On this, Benditt adds that “much work is required in this area as one cannot assume that all POTS-like scenarios will have the same consequences or respond similarly to the same treatments. A focus on establishing a pertinent diagnosis is needed via clinical investigation.”