Long-Haul Post–COVID-19 Symptoms Presenting as a Variant of Postural Orthostatic Tachycardia Syndrome: The Swedish Experience, 2021, Johansson et al

Abstract

Major clinical centers in Sweden have witnessed an inflow of patients with chronic symptoms following initial outpatient care for coronavirus disease-2019 (COVID-19) infection, suggestive of postural orthostatic tachycardia syndrome. This report presents the first case series of 3 Swedish patients diagnosed with postural orthostatic tachycardia syndrome more than 3 months after the primary COVID-2019 infections. (Level of Difficulty: Beginner.)

Open access: https://www.jacc.org/doi/10.1016/j.jaccas.2021.01.009

 

I have a friend in the states who is really struggling with post-Covid POTS.

 

 Exercise training Aerobic: 30+ min 4 days/week with some leg resistance training Will initially feel poorly and/or worse for up to 6 weeks Initial recumbent exercise, such as a rowing machine, recumbent cycle, or swimming are preferred . started out well recognising pots as a common symptom and then they add this ffs

 

Even if you are well, but merely deconditioned, that recommendation is far from ideal from an exercise physiology perspective. More time at a constant intensity (rather than shorter amounts of exercise at varying levels of intensity) and more times per week isn't necessarily better, especially when getting started.

 

This January article on Post-Covid POTS said:

I'm not sure if myocarditis (inflammation of the heart muscle) is supposed to be a cause of POTS, but, if asymptomatic COVID-19 patients were developing POTS, wouldn't that pretty much undermine the idea that POTS is related to deconditioning? I mean, if you've been generally asymptomatic, it's pretty hard to attribute your rapid heart beat upon standing to too much bed rest.

I don't know for a fact if POTS is commonly attributed to deconditioning. All I know is that when doctors saw my high heart rate (and other symptoms) upon standing they just recommended more exercise (which was no help at all).

 

Reading about POTS it seems to me that it is not a single disease, but something that is the end point of different things that are going wrong in the body and so considering it as one process could lead to inappropriate treatments for many people.

Off the top of my head, there could be vascular causes, neuropathic causes, brain damage, heart damage and so on.

 

And if you look at orthostatic intolerance rather than just those that meet the diagnostic criteria for POTS the potential for heterogeneity becomes even greater.

 

I remembered reading somewhere that heart problems should be ruled out before a diagnosis of POTS and wanted to look it up but then ended up on this POTS website, where I got distracted by the list of associated conditions. They included hypermobility and MCAS but not ME/CFS, how odd: https://www.potsuk.org/associated_conditions2

 

Fallstudie belyser pots vid långtidscovid
https://www.lu.se/artikel/fallstudie-belyser-pots-vid-langtidscovid

Google Translate, English

 

När pulsen rusar vid långtidscovid
https://www.forskning.se/2021/04/12/nar-pulsen-rusar-vid-langtidscovid/

Google Translate, English

 

This new technology may be interesting
https://physicsworld.com/a/ultrafast-ultrasound-maps-tiny-blood-vessels-deep-in-the-human-brain/