Young Women With Symptomatic Long COVID At Higher Risk of POTS

A cohort of predominantly younger women with highly symptomatic post-COVID-19 sequalae (PCS), also known as long COVID, demonstrated common incidence of postural orthostatic tachycardia syndrome (POTS), according to new research published in Circulation: Arrhythmia and Electrophysiology.¹

The observations show significantly lower physical activity and capacity compared with non-POTS long COVID, researchers said.

What is POTS?

POTS is a condition that leads to a faster-than-normal heartbeat when transitioning from sitting or lying down to standing up. A type of orthostatic intolerance, patients with POTS may also experience a faster heartbeat at rest and during physical exertion. The patients' bodies cannot adequately coordinate the balance of blood vessel squeezing and heart rate response, meaning a patient’s blood pressure fluctuates and is unstable.^2,3

Although every case of POTS varies, hallmark symptoms include experiencing fatigue and difficulties concentrating. Long COVID features overlapping presentations, including fatigue and neurological complications that can last for weeks or months following a COVID-19 infection. Since these conditions have such similar features, practitioners can find it difficult to determine their association and whether one can contribute to the other, especially in the wake of the COVID-19 pandemic.^2-4

There has been growing concern regarding the incidence of POTS in long COVID since the latter first appeared in 2021. Determining their association with each other could offer critical insights to pharmacists and other health care providers as they manage the complexities of long COVID. If POTS is found in more patients than originally expected, pharmacists could offer more specific, tailored management strategies that could potentially improve patient prognosis and outcomes.^1,2

Current investigators initiated a prospective analysis to determine the clinical impact of POTS in a series of well-characterized patients with long COVID. The researchers, from Karolinska Institutet in Sweden, stated it would be the largest and most detailed to date on the link between long COVID and POTS.¹

What is the Link Between POTS and Long COVID?

A total of 467 nonhospitalized, highly symptomatic patients with long COVID were prospectively analyzed, 91% of whom were middle-aged women who were healthy and physically active before they developed long COVID. At a median of 12 months after acute COVID-19, examinations were performed, followed by a cardiologist evaluation—featuring a 48-hour electrocardiogram, head-up tilt test, and Active Stand Test for patients with clinically suspected POTS.^1,2

Of the total patients with long COVID, 143 (31%) were diagnosed with POTS, 128 (27%) did not fulfill criteria for POTS, and 196 (42%) had no clinical signs of POTS. Patients with POTS had significantly lower physical activity compared with the other 2 groups as measured by the Frändin-Grimby scale (P = .001). Furthermore, heart rates during the 6-minute walk test were meaningfully higher in the POTS group both during walking and at rest afterwards, with significantly shorter walking distance (448 m versus 472 m versus 509 m, respectively; P ≤ .001).¹

“Previous, smaller studies have shown that there is a connection, but now we can say with certainty that POTS is a very common condition in patients with long COVID. This is valuable knowledge for both healthcare professionals and patients,” Mikael Björnson, doctoral student at the Department of Medicine, Solna, Karolinska Institutet, said in a news release accompanying the study results.²

These insights reveal that POTS is a common presentation in younger women with long COVID, offering a new point of counseling for pharmacists and patients. The investigators recommend that patients with long COVID who experience significant increases in heart rate when changing position from lying to standing and during exertion, and who experience neurological symptoms such as brain fog and fatigue, are investigated for POTS.²

“It is important to know that POTS can be detected with inexpensive, simple tests that are available at all levels of health care,” Judith Bruchfeld, associate professor at Karolinska Institutet, senior consultant in infectious diseases at Karolinska University Hospital and head of the study, said in a news release. “For those who receive a diagnosis, there are treatments that can alleviate symptoms and improve quality of life.”²

REFERENCES

1. Björnson M, Wijnbladh K, Tornberg A, et al. Prevalence and clinical impact of postural orthostatic tachycardia syndrome in highly symptomatic long COVID. Circulation. 2025. doi:10.1161/CIRCEP.124.013629

2. Karolinska Institutet. POTS common in patients with long COVID. EurekAlert! News Release. Released October 3, 2025. Accessed October 13, 2025. https://www.eurekalert.org/news-releases/1100722

3. Postural orthostatic tachycardia syndrome (POTS). Cleveland Clinic. Last Updated September 9, 2022. Accessed October 13, 2025. https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots

4. Long COVID—Long COVID signs and symptoms. CDC. Last Updated July 24, 2025. Accessed October 13, 2025. https://www.cdc.gov/long-covid/signs-symptoms/index.html