Most in the general public would not recognize the word dysautonomia nor the syndrome called POTS. For those suffering with postural orthostatic tachycardia syndrome (POTS), a type of dysautonomia, or dysregulation of our autonomic control system, they can’t forget it. The dizziness, palpitations, syncopal episodes, fatigue, and sometimes inability to function well while standing upright rarely leave them alone. While not a very frequent complication in Long Hauler’s COVID, POTS or dysautonomia may leave patients feeling all of these symptoms and more post COVID infection.
According to the three articles in focus, Long Hauler COVID, the various symptoms left over after an acute COVID infection, sometimes include documented POTS or dysautonomia. While the article by Elllul provides statistics that traditionally diagnosed neurological issues like encephalitis (brain inflammation), stroke, and other neuropathies are likely less than 1/10th of one percent, the articles by Shouman, Blitshteyn and Goodman point out that we are just beginning to document and understand the prevalence of neurological effects of COVID 19, particularly POTS.
Focusing just on dysautonomia and POTS for the moment, the three articles look at small groups of Post COVID patients who have been evaluated systematically with a series of tests that would normally be used for POTS patients. While the exclusion criteria varied between the studies, each attempted to exclude any patients with other diagnoses that would explain the reported symptoms. The symptoms of dizziness, postural lightheadedness, fatigue, near-syncope, and intolerance to activity brought the patients seeking help. Tests were done to exclude pre-existing conditions like hypothyroid or those already having POTS or other complications of COVID that would directly cause the symptoms.
Once screened for other symptom explanations, patients were put through the typical dysautonomia tests. A variety of results came out of these tests. Some demonstrated postural tachycardia similar to other POTS cases. Some demonstrated orthostatic hypotension. One demonstrated sudomotor abnormalities or changes in sweat function. From the Shouman article, “One patient each was diagnosed with autoimmune autonomic ganglionopathy, inappropriate sinus tachycardia, vasodepressor syncope, cough/vasovagal syncope, exacerbation of preexisting orthostatic hypotension, exacerbation of sensory and autonomic neuropathy, and exacerbation of small fiber neuropathy.”
Given the possible link between infections and POTS noted in other research (Blitshteyn, Thieben, Fedorowski, Hongliang), finding it in post COVID patients is not surprising. The article by Hongliang also links POTS with auto-antibodies. In functional medicine, as we followed the research we have known that viruses can trigger both autoimmune and chronic inflammatory conditions which damage other body systems. In helping our patients with Long Hauler COVID return to healthier more abundant lives, we apply the basic principles that have shown success in other patients. Find root causes that either cause disease or prevent recovery and address them. So far, it seems to be working in these patients as well.
Articles in Focus:
Blitshteyn, Svetlana, and Sera Whitelaw. “Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after COVID-19 infection: a case series of 20 patients.” Immunologic research vol. 69,2 (2021): 205-211. doi:10.1007/s12026-021-09185-5
Goodman, Brent P et al. “COVID-19 Dysautonomia.” Frontiers in neurology vol. 12 624968. 13 Apr. 2021, doi:10.3389/fneur.2021.624968
Shouman, Kamal et al. “Autonomic dysfunction following COVID-19 infection: an early experience.” Clinical autonomic research : official journal of the Clinical Autonomic Research Society vol. 31,3 (2021): 385-394. doi:10.1007/s10286-021-00803-8
Additional References:
1) Thieben, Mark J et al. “Postural orthostatic tachycardia syndrome: the Mayo clinic experience.” Mayo Clinic proceedings vol. 82,3 (2007): 308-13. doi:10.4065/82.3.308
2) Fedorowski, A. “Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management.” Journal of internal medicine vol. 285,4 (2019): 352-366. doi:10.1111/joim.12852
Li, Hongliang et al. “Autoimmune basis for postural tachycardia syndrome.” Journal of the American Heart Association vol. 3,1 e000755. 26 Feb. 2014, doi:10.1161/JAHA.113.00075511
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.
