Post-COVID postural orthostatic tachycardia syndrome (POTS): a new phenomenon

Christopher Cantrell; Conor Reid; Claudia S Walker; Samantha J Stallkamp Tidd; Ryan Zhang; Robert Wilson

doi:10.3389/fneur.2024.1297964

Post-COVID postural orthostatic tachycardia syndrome (POTS): a new phenomenon

Front Neurol. 2024 Mar 22:15:1297964. doi: 10.3389/fneur.2024.1297964. eCollection 2024.

Authors

Christopher Cantrell¹, Conor Reid¹, Claudia S Walker¹, Samantha J Stallkamp Tidd¹, Ryan Zhang², Robert Wilson^{1

3}

Affiliations

¹ Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States.
² Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
³ Department of Neuromuscular Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States.

Abstract

Background: The impact of COVID-19 has been far-reaching, and the field of neurology is no exception. Due to the long-hauler effect, a variety of chronic health consequences have occurred for some post-COVID patients. A subset of these long-hauler patients experienced symptoms of autonomic dysfunction and tested positive for postural orthostatic tachycardia syndrome (POTS) via autonomic testing.

Methods: We conducted a chart review of a convenience sample from patients seen by neurologists at our tertiary care center for suspicion of post-COVID POTS. Patients included in our study had clearly defined POTS based on clinical criteria and positive tilt table test, were 81.25% female, and had an average age of approximately 36. Out of 16 patients, 12 had a confirmed positive COVID test result, with the remaining 4 having strong clinical suspicion for COVID infection. Our analysis examined the most bothersome 3 symptoms affecting each patient per the neurologist's note at their initial visit for post-COVID POTS, clinical presentation, comorbidities, neurological exam findings, autonomic testing results, and COMPASS-31 autonomic questionnaire and PROMIS fatigue survey results.

Results: Palpitations (68.75%) and fatigue (62.5%) were the most common of the impactful symptoms reported by patients in their initial Cleveland Clinic neurology visit. The most frequent comorbidities in our sample were chronic migraines (37.5%), irritable bowel syndrome (IBS) (18.75%), and Raynaud's (18.75%). Neurological exam findings and autonomic testing results other than tilt table yielded variable findings without clear trends. Survey results showed substantial autonomic symptom burden (COMPASS-31 autonomic questionnaire average score 44.45) and high levels of fatigue (PROMIS fatigue survey average score 64.64) in post-COVID POTS patients.

Conclusion: Our sample of post-COVID POTS patients are similar to the diagnosed POTS general population including in comorbidities and autonomic testing. Fatigue was identified by patients as a common and debilitating symptom. We hope that our study will be an early step toward further investigation of post-COVID POTS with focus on the trends identified in this chart review.

Keywords: COVID; POTS; autonomic; long-hauler; neurology; orthostatic; post-COVID.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research conducted for this study was funded solely by the Autonomic Fund provided to the Neuromuscular Department of the Cleveland Clinic Neurological Institute (project # T56503).