What POTS feels like
You stand up, and your heart suddenly races. You feel lightheaded, maybe nauseated, your legs feel heavy. After a few minutes you have to sit down again. Getting through a shower feels like a workout.
This is POTS — Postural Orthostatic Tachycardia Syndrome. It's when your heart rate jumps 30+ beats per minute (40+ for teenagers) within 10 minutes of standing, without a big drop in blood pressure.
Why it happens in Long COVID
Your autonomic nervous system controls the stuff you don't think about: heart rate, blood pressure, digestion, body temperature. In Long COVID, this system often goes haywire. The research suggests several possible causes:
- Small fiber neuropathy — damage to the tiny nerves that regulate blood vessels
- Low blood volume (hypovolemia) — your body has less circulating fluid than it should
- Deconditioning — after months of reduced activity, your system gets worse at handling position changes (but it's not just deconditioning)
- Autoimmune components — antibodies that attack the autonomic nervous system
What the numbers say
- Estimated 2 to 14 million Americans had POTS before COVID. Numbers have grown dramatically since 2020.
- Studies find POTS-like symptoms in up to 30% of Long COVID patients.
- POTS disproportionately affects women (80%+) and often starts in the late teens to 30s.
What actually helps (from research)
Non-pharmacological (try these first):
- Increase salt and fluid intake — 10-12 g salt/day and 2-3 liters water/day (with doctor's approval)
- Compression garments — waist-high 20-30 mmHg compression is more effective than stockings alone
- Elevate the head of your bed — 10-15 cm elevation helps reduce morning symptoms
- Recumbent exercise — recumbent bike, rowing machine, swimming. Upright exercise makes POTS worse until you're more conditioned
Medications (discuss with your doctor):
- Ivabradine — slows heart rate without affecting blood pressure. Germany now covers this off-label for LC patients.
- Beta-blockers (low dose) — propranolol or nadolol
- Midodrine — raises blood pressure
- Fludrocortisone — helps retain sodium and fluid
Practical tips for hard moments
- Sit-to-stand slowly. Count to 10 before you actually stand up.
- Cross your legs and squeeze when standing still — this pushes blood up
- Drink a cold glass of water before standing — it actually triggers a blood pressure response
- Avoid hot showers in the morning — heat dilates blood vessels and makes POTS worse