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Long COVID: Palpitations, Tachycardia, and Postural Orthostatic Tachycardia Syndrome (POTS)

What Are Palpitations?

Palpitations occur in some people with long COVID. It means you feel your heart beating in your chest. You may feel a skipped beat. You may also feel like your heart is beating fast, beating hard/pounding, or fluttering. Palpitations can occur at any time - i.e. they may or may not be related to certain activities, etc.. How long they last also varies.

What Is Tachycardia?

Tachycardia is a fast heart rate - it’s when your heart beats at least 100 times a minute. Certain medical conditions, medications, drugs, etc. may cause tachycardia.

Tachycardia may occur in people with long COVID for a number of reasons. It may be from a heart problem. Other possible causes include:

  • Low oxygen levels

  • Blood disorders 

  • Fever

  • Dehydration

  • Deconditioning or changes related to inactivity

  • Anxiety and stress

What Is Orthostatic Intolerance?

Orthostatic intolerance is when you experience symptoms of palpitations, lightheadedness, feeling shaky or weak, chest tightness, or difficulty breathing upon standing up, that improves with lying back down.

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. People with POTS may also have other symptoms including decreased ability to exercise, headache, brain fog, musculoskeletal pain, and gastrointestinal problems. 

POTS is related to nervous system dysfunction and affects heart rate, blood pressure, etc. Researchers are continuing to study the reasons why POTS occurs in people with long COVID.

How Common Are Palpitations, Tachycardia, and POTS in Long COVID?

Palpitations, tachycardia, and POTS may all occur in people with long COVID. The exact number of people with each of them is unknown, though some information is available:

  • A study found 9.0% of people with long COVID had palpitations six months after initial infection.

  • Between 25-50% of patients at a post-COVID clinic had tachycardia or palpitations 12 weeks or more after initial COVID infection.

  • One study found about 30% of people with long COVID had signs and symptoms that suggest POTS.

Should I Contact My Doctor For My Palpitations?

You should contact your doctor for your palpitations. They will talk with you about your symptoms and perform a physical exam. They may also check your heart with an electrocardiogram (ECG) to measure the electrical activity of your heart. 

IMPORTANT

You should get immediate care if you are over 60 years old and you have palpitations with chest pain, dizziness, fainting, or blackouts. Be extra cautious if you have a history of heart disease like an irregular heart rhythm (arrhythmia), coronary artery disease (CAD), or heart failure.

What Can I Do To Help Lessen Palpitations?

You should avoid foods, drinks, and over-the-counter (OTC) medicines containing stimulants. Stimulants increase blood pressure, heart and breathing rates.

Should I Contact My Doctor if I Have POTS Symptoms?

You should contact your doctor if you have symptoms of POTS. They can check your heart rate and blood pressure when you are in different positions (i.e. lying down, standing up). They can order other tests to evaluate for POTS, as well as prescribe medications if needed.

What Can I Do To Help Lessen My POTS Symptoms?

Try the following to help to improve your symptoms:

  • Stay hydrated. Have water near your bed so you can drink it first thing in the morning. 

  • Add more salt to your diet. *Note: If you have high blood pressure, heart failure, or kidney problems, do not add salt.

  • Avoid any triggers that could worsen your symptoms such as:

    • Sudden position changes (instead, move slowly when you stand up. If you are lying down, sit for 1-2 minutes before standing up)

    • Long periods of sitting or lying down flat (instead, sleep with your head elevated e.g. use a wedge pillow)

    • Hot temperatures

    • Large meals

    • Alcohol

    • Caffeine 

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

If you feel like you might faint, try one of the following:

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

  • Make fists with both hands

  • Cross your legs

How Long Do Palpitations, Tachycardia, and POTS last?

Experts don’t know how long these symptoms may last, but it may range from weeks to months.If you have questions about your symptoms or any of the recommendations for treating them, contact your Goodpath coach.