Long-Haul Post-COVID-19 Symptoms Presenting as a Variant of Postural Orthostatic Tachycardia Syndrome: The Swedish Experience

Abstract

Major clinical centers in Sweden have witnessed an inflow of patients with chronic symptoms following initial outpatient care for coronavirus disease-2019 (COVID-19) infection, suggestive of postural orthostatic tachycardia syndrome. This report presents the first case series of 3 Swedish patients diagnosed with postural orthostatic tachycardia syndrome more than 3 months after the primary COVID-2019 infections. (Level of Difficulty: Intermediate.).

Keywords: BP, blood pressure; COVID-19 infection; COVID-19, coronavirus disease-2019; HR, heart rate; POTS, postural orthostatic tachycardia syndrome; SARS-CoV-2, severe acute respiratory syndrome-coronavirus-2; autonomic dysfunction; complications; orthostatic intolerance; postural orthostatic tachycardia syndrome.

Graphical abstract

Figure 1

POTS Symptom Scoring in 42-Year-Old Woman Patient #1 self-reported symptoms using a dedicated postural orthostatic tachycardia syndrome (POTS) symptom scoring questionnaire composed of 12 most commonly reported symptoms in POTS. Patients were asked to grade their symptoms using a visual analogue scale (VAS) ranging from 0 (no symptom) to 10 (worst possible). The maximum score is 120 points. A score >40 points likely indicates pathology.

Figure 2

HUT Testing in 42-Year-Old Woman Head-up tilt (HUT) test revealing post–coronavirus disease-2019 POTS in a 42-year-old woman (Patient #1), with red arrows indicating the marked increase in heart rate (HR) during orthostasis. bpm = beats/min; Diz = dizziness; POTS = postural orthostatic tachycardia syndrome.

Figure 3

Active Standing in 42-Year-Old Woman Active standing test demonstrating initial orthostatic hypotension and POTS in a 42-year-old woman (Patient #1) with long-haul post–coronavirus disease-2019 symptoms, with red arrow indicating the marked increase in heart rate during orthostasis. Abbreviations as in Figures 1 and2.

Figure 4

Valsalva Response in 42-Year-Old Woman Hyperadrenergic Valsalva maneuver in a 42-year-old woman (Patient #1) with long-haul post–coronavirus disease 2019 symptoms, with red arrows indicating the marked increase in heart rate and blood pressure (hyperadrenergic response). Abbreviations as in Figure 2.

Figure 5

POTS Symptom Scoring in 28-Year-Old Woman Patient #2 self-reported symptoms using a dedicated POTS symptom scoring questionnaire composed of 12 most commonly reported symptoms in POTS. Patients were asked to grade their symptoms using a VAS ranging from 0 (no symptom) to 10 (worst possible). The maximum score is 120 points. A score >40 points likely indicates pathology. Abbreviations as in Figure 1.

Figure 6

POTS Symptom Scoring in 37-Year-Old Man Patient #3 self-reported symptoms using a dedicated POTS symptom scoring questionnaire composed of 12 most commonly reported symptoms in POTS. Patients were asked to grade their symptoms using a VAS ranging from 0 (no symptom) to 10 (worst possible). The maximum score is 120 points. A score >40 points likely indicates pathology. Abbreviations as in Figure 1.