Postural Orthostatic Tachycardia Syndrome (PoTS) in Long Covid & ME/CFS

April 12, 2021

New position statement from the American Autonomic Society on PoTS and Long Covid


While the acute impacts of COVID-19 were the initial focus of concern, it is becoming clear that in the wake of COVID-19, many patients are developing chronic symptoms that have been called Long-COVID. Some of the symptoms and signs include those of postural tachycardia syndrome (PoTS). Understanding and managing long-COVID PoTS will require a significant infusion of health care resources and a significant additional research investment. In this document from the American Autonomic Society, we outline the scope of the problem, and the resources and research needed to properly address the impact of Long-COVID PoTS

This review paper in the Journal of the Royal College of Physicians is devoted to the presence of ANS dysfunction in Long Covid. where much of the background and management information is also relevant to ANS dysfunction in ME/CFS – apart from the section on activity management and exercise.

Dr Charles Shepherd comments

Dr Charles Shepherd
Hon. Medical Adviser ME Association


One of the very important clinical and neurological overlaps between ME/CFS and Long Covid is thepresence of what is called autonomic nervous system (ANS) dysfunction, also known as dysautonomia.

From control systems in the brain, the ANS sends out messages to the heart, bowel and bladder to basically either speed them up or slow them down through what are known as the sympathetic and parasympathetic nervous systems.

In relation to the cardiovascular system, the ANS plays a very important part in altering heart rate and blood pressure when changes take place in posture from lying or sitting to standing.

The aim is to make sure that when we move from lying or sitting to standing, there are rapid compensatory mechanisms in place to ensure that when approx 750 mls blood heads south in the body there is still enough blood being pumped north to the brain.

When this vital neurological/cardiovascular control system becomes defective people have problems when standing up and/or maintaining an upright posture – which is known as orthostatic intolerance (OI).

OI is a common and often overlooked symptom of ME/CFS. If the blood pressure falls too much during a change in posture from lying to standing this is known as orthostatic hypotension.

Both conditions can cause dizziness, lightheadedness, blurred vision, mental confusion, nausea and feeling faint, or even fainting. If the pulse rate rises excessively when moving from lying to standing this is known as postural orthostatic tachycardia syndrome (PoTS).

All three of these important aspects of ANS dysfunction/orthostatic intolerance can occur in both ME/CFS and Long Covid.

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