Image description: The main picture shows a person feeling dizzy. The inset pictures show a person lying in a chair covered by a blanket. The second one shows a person having their blood pressure taken. The title reads POTS and Long COVID: A Dizzying Partnership. The MEA logo bottom right.

POTS and Long COVID: A Dizzying Partnership

What we understand about the relationship between long COVID and POTS.

Psychology today by Jennifer Henderson Ph.D.


  • Postural orthostatic tachycardia syndrome, a form of dysautonomia, often develops after COVID-19 illness.
  • Recent research shows that 30 percent of long-haulers meet criteria for POTS.
  • POTS causes symptoms including lightheadedness, fainting, heart palpitations, and shakiness.
  • Self-management of POTS is possible with simple lifestyle changes.


Long-haulers struggle with a multitude of lingering and often disabling symptoms. One particularly troubling cluster of symptoms is autonomic nervous system dysfunction. In fact, a recent international survey revealed that 67 percent of long-haulers report moderate to severe autonomic dysfunction (i.e., dysautonomia). Unfortunately, one of the most common forms of dysautonomia among long-haulers—Postural Orthostatic Tachycardia Syndrome, or POTS—is infrequently recognized and diagnosed.

What is the connection between long COVID, dysautonomia, and the new onset of POTS? This post aims to answer that question.

The autonomic nervous system (ANS) is responsible for vital involuntary bodily functions, such as breathing and digestion. The ANS can be divided into three separate divisions:

  • Parasympathetic (responsible for “rest and digest” bodily processes)
  • Sympathetic (governs “fight or flight” processes)
  • Enteric (manages how the body digests food)

What is dysautonomia?

When our autonomic nervous system doesn’t function as it should, it can cause a broad spectrum of symptoms. We may experience GI problems like constipation, heart palpitations, lightheadedness, heat intolerance, and excessive thirst or fatigue.

Viral infections like COVID-19 may cause a specific type of dysautonomia: POTS. Researchers are consistently finding a strong link between COVID-19 infection and the development of POTS in patients who previously didn’t experience dysautonomia. Research has shown that the emergence of dysautonomia in long COVID patients is not associated with the severity of the original COVID-19 infection.

What is POTS?

Postural orthostatic tachycardia syndrome is a form of dysautonomia. People who have POTS will experience a marked increase in their heart rate whenever they stand up. Normally, the ANS balances heart rate and blood pressure regardless of your body’s positioning. If you have POTS, however, the ANS can’t perform this important function.

Imagine standing up. When you do, gravity pulls blood to the lower part of your body. Your ANS attempts to compensate for this by increasing your heart rate to increase blood flow to your heart and brain. Your nervous system will return to normal functioning once your brain has received sufficient blood and oxygen.

How is POTS diagnosed and treated?

The symptoms of POTS may resemble a variety of other medical conditions, which can complicate diagnosing. When you consult with a physician about these symptoms, the doctor will likely perform a physical exam and order bloodwork to determine what, if any, other factors may be causing your symptoms. A diagnosis of POTS is typically made by using a standing or tilt-table test.

The NHS has some helpful tips to help you manage your symptoms:

The ME Association has a range of reliable information leaflets written by our expert advisers. These can be found in our shop or by clicking the links below.

Orthostatic Intolerance

We explain what might be causing loss of balance and dizziness when moving from sitting/lying to standing, and how this can be managed. 

OI is a symptom that affects most people with ME/CFS to some degree and it is now recognised as a key diagnostic feature.

Postural Orthostatic Tachycardia Syndrome (PoTS)

We explain what PoTS is, how it relates to orthostatic intolerance, why it affects some people with ME/CFS, and how it can be diagnosed and treated.

Medical Matters:

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