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A newly published study has established a significant link between long COVID and an abnormal heart rhythm disorder called Postural Orthostatic Tachycardia Syndrome (POTS), with a notably higher prevalence among middle-aged women. This discovery sheds light on the cardiovascular complications affecting many people experiencing prolonged symptoms after acute COVID-19 infection. The research offers critical insights into a condition that impairs quality of life and highlights the need for awareness, early diagnosis, and symptom management.
Key Findings on POTS and Long COVID
The study, conducted by researchers at Karolinska Institutet in Sweden and published in the peer-reviewed journal Circulation: Arrhythmia and Electrophysiology in October 2025, examined 467 patients with severe long COVID who had not been hospitalized during their initial COVID infections. Of these, 91% were middle-aged women, mostly healthy and physically active before developing long COVID symptoms.
Results revealed that POTS, a disorder characterized by an abnormally fast heart rate when moving from lying down to standing up, was diagnosed in nearly one-third (31%) of the participants. An additional 27% experienced symptoms consistent with POTS but did not meet full diagnostic criteria, while 42% showed no signs of the condition. Individuals with POTS faced challenges standing without dizziness, had persistent fatigue, and difficulty concentrating—symptoms commonly overlapping with long COVID. They also displayed significantly higher heart rates during walking tests and reported a poorer quality of life than those without the disorder.
Understanding Postural Orthostatic Tachycardia Syndrome (POTS)
POTS is a form of dysautonomia, meaning it affects the autonomic nervous system that controls involuntary bodily functions such as heartbeat and blood pressure regulation. When people with POTS stand up, blood pools in the lower extremities, triggering an abnormal increase in heart rate to maintain adequate blood flow to the brain. This rapid heartbeat can cause dizziness, lightheadedness, fatigue, and brain fog, interfering with everyday activities.
Experts explain that POTS is not caused by heart disease per se but reflects a dysfunction in nervous system regulation of cardiovascular function. This makes it particularly relevant in post-viral syndromes like long COVID, where immune and autonomic nervous system responses may be disrupted.
Expert Perspectives
Mikael Björnson, a doctoral student at Karolinska Institutet and lead researcher on the study, emphasized that while previous smaller studies hinted at a connection between POTS and long COVID, this comprehensive study confirms that POTS is very common among this group. He considers this knowledge valuable for both patients and healthcare professionals as it informs appropriate diagnosis and care strategies.
Judith Bruchfeld, Associate Professor at Karolinska Institutet, stressed the importance of early recognition. She notes that POTS can be diagnosed through simple and inexpensive tests accessible in most healthcare settings. Importantly, treatment options, including lifestyle modifications and medications, can help alleviate symptoms and improve quality of life, underscoring the need for better awareness.
Context and Cardiovascular Implications of Long COVID
Beyond POTS, long COVID has been linked to a broader spectrum of cardiovascular issues, including myocarditis (inflammation of the heart muscle), arrhythmias (irregular heartbeats), and endothelial dysfunction (damage to blood vessel linings). SARS-CoV-2, the virus causing COVID-19, can induce persistent inflammation and immune dysregulation, which may contribute to these complications even months after the acute infection phase.
A systematic review of cardiovascular effects in COVID-19 survivors found that endothelial injury and chronic inflammation elevate risks for hypertension, thrombosis, and heart failure. The post-COVID cardiovascular burden is a growing public health concern requiring ongoing monitoring and research.
Public Health and Practical Implications
This research has several important implications for public health and individuals managing long COVID:
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Increased Awareness: Clinicians should consider POTS in patients reporting dizziness, rapid heart rate upon standing, fatigue, and cognitive difficulties post-COVID, particularly in middle-aged women.
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Accessibility of Diagnosis: Since POTS testing involves simple heart rate and blood pressure measurements during position changes, it can be incorporated into routine follow-ups for long COVID patients.
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Treatment and Symptom Management: Patients diagnosed with POTS may benefit from increased fluid and salt intake, physical therapy focusing on gradual exercise, compression garments, and medications targeting heart rate and blood vessel tone.
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Patient Education: Empowering patients with knowledge about their symptoms and management strategies can improve quality of life and reduce anxiety related to unexplained symptoms.
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Need for Long-Term Monitoring: As the long-term cardiovascular consequences of COVID-19 continue to emerge, healthcare systems must adapt to provide multidisciplinary care for affected individuals.
Limitations and Considerations
While this study is the largest to date linking POTS with long COVID, it focused on a cohort not hospitalized for acute COVID-19, and predominantly on middle-aged women, limiting generalizability to other populations, such as men or younger people. The diagnostic criteria for POTS can be nuanced, and some patients may have overlapping conditions contributing to symptoms. Additionally, long COVID is a complex, multifactorial syndrome with varying manifestations; not all symptoms may be attributable to POTS alone.
Further research is necessary to elucidate the pathophysiology fully, explore gender differences, and evaluate optimal therapeutic interventions across diverse populations.
Conclusion
The compelling evidence connecting long COVID to Postural Orthostatic Tachycardia Syndrome, especially among middle-aged women, highlights an often overlooked but significant cardiovascular complication of the pandemic. Recognition of POTS as a common and treatable contributor to persistent symptoms can transform patient care and outcomes. As research unfolds, this knowledge underscores the importance of comprehensive cardiovascular evaluation in the ongoing management of long COVID survivors.
Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.
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