Long COVID: Orthostatic Intolerance

Orthostatic Intolerance

One of the symptoms of long COVID is called orthostatic intolerance. Orthostatic means you’re in an upright posture or a standing position. Intolerance, in this context, means you are overly sensitive. When a person with orthostatic intolerance stands up, they develop certain symptoms.

What are the Symptoms of Orthostatic Intolerance?

The symptoms of orthostatic intolerance occur when you go from lying down or sitting to standing. They include feeling faint (lightheadedness), experiencing a rapid heart beat (palpitations), feeling shaky or weak, having chest tightness, and/or difficulty breathing. The symptoms improve when you lie down. 

What Causes Orthostatic Intolerance in Long COVID?

Doctors believe that the COVID-19 virus, or the immune system response to the virus, may cause dysautonomia - i.e. a disruption of the function of the autonomic nervous system (ANS). The ANS is the part of the nervous system that controls automatic body processes like heart rate, blood pressure, breathing, etc. 

What Is Postural Orthostatic Tachycardia Syndrome (POTS)?

Some people with long COVID have a type of orthostatic intolerance called Postural Orthostatic Tachycardia Syndrome (POTS), with the symptoms described above. With POTS, your heart rate increases by at least 30 beats per minute when standing up. One study found about 30% of people with long COVID had signs and symptoms that suggest POTS

There are different forms of POTS in long COVID. People with POTS may have other symptoms related to dysautonomia such as nausea, belly (abdominal) discomfort, diarrhea or constipation, skin discoloration, and abnormal sweating. 

Should I Contact My Doctor if I Have Orthostatic Intolerance?

Yes, you should contact your doctor. They can check your heart rate and blood pressure when you are in different positions (i.e. lying down, standing up) to determine your type of orthostatic intolerance. If needed, they can order tests to check for conditions such as POTS, if they haven't done so already. 

What Can I Do To Help Lessen My Symptoms?

Try the following to help lessen your symptoms:

  • Stay hydrated. Drink water throughout the day. Aim for 2 to 3 liters a day. Have water near your bed so you can drink it first thing in the morning

  • Add more salt to your diet. Target up to 10 grams a day.

*Note: If you have high blood pressure, heart failure, or kidney problems, these solutions may not be suitable for you - please stick to the fluid and salt restriction outlined by your doctor*

  • Avoid triggers, such as the following, that could worsen your symptoms

    • Sudden position changes. Instead, move slowly when you stand up. For example, if you are lying down, sit for 1-2 minutes before standing up

    • Long periods of sitting or lying down flat. Instead, for example, sleep with your head elevated with a wedge pillow

    • Hot temperatures

    • Large meals. Instead, eat smaller amounts more frequently

    • Alcohol

    • Caffeine

  • Wear a compression garment. Talk with your doctor about the type you should use

  • Follow the Four Ps (Plan, Pace, Prioritize, and Position) if you have severe fatigue related to your symptoms

    • Plan your daily activities, but realize your plans may change

    • Pace your activities with rest throughout the day

    • Prioritize what is most important while acknowledging that you have some limitations

    • Position items in your environment to make them easier to use and change your position to avoid muscle fatigue

  • If you feel like you might faint, try one of these techniques:

    • While sitting, fold your arms and lean forward

    • Cross your arms and legs

    • Squeeze your buttocks and tighten your belly (abdominal) muscles

    • Make fists with both hands

If you have questions about your symptoms or any of the recommendations for treating them, contact your Goodpath coach.