Long Covid and POTS

POTS is abnormal response to upright posture that causes what two things?

Orthostatic tolerance and excessive tachycardia w/o hypotension

Covid 19 survivors develop POTS within how many months of infection?

6-8 months

POTS sx?

Fatigue, Orthostatic intolerance, tachycardia and cognitive impairment

What are 4 possible mechanism of POTS?

Hypovolemia and deconditioning

Autoimmunity

Neuropathy

Neuroendocrine dysfunction

POTS sx:

Increase in HR greater than or equal to what? Associated with Hypotension?

How is HR in <20 year olds?

30 bpm and no Hypotension

Greater or equal to 40 bpm

Orthostatic POTS Sx (6)

Occurs when? Relieved when?

Dizzy, heart palpatation, fainting, too much or too little sweating, breathing trouble and chest pain

When patient stands and relieved when laying down

Orthostatic POTS worsens when?

Physical activity, eating, bathing, hot temperatures and period

Is non Orthostatic POTS dependent on position?

Sx?

Nah

Anxiety, severe HA and change in sleeping, GI and bladder issues, Skin changes , cognitive dysfunction

Pt with POTS should undergo what 4 things?

Autonomic testing( tilt table testing and sudomotor testing)

Lab values

Differentia Dx:(6)

Orthostatic Hypotension

Hypovalemia

Medication induced tachycardia

Inappropriate sinus tachycardia

Reflex syncope

Anxiety

Covid shot increases risk of POTS how many days after vaccine?

What is the mechanism?

90 days

Autoimmune

Non Pharmacological mgmt:

How many L of water and how many g of sodium?

If you can’t drink water, how much IV?

3L/day and 8-12 g

1-2 L

What should ppl with POTS avoid?

Daytime sleeping and prolonged bed rest

What is more effective a compression stocking or abdominal binder?

Abdominal binder

What does a compression garment and abdominal bind do do venous pooling ?

Reduces it

For a patient with Orthostatic tachycardia, what drug should you use?

Beta blocker but Ivabradine can also be used

For pts with sudomotor or vasomotor symptoms, what therapy is more effective?

Vasopressin therapy

What does Fludrocortisone and Midodrine help with?

Orthostatic intolerance

What does pyridostigmine help with?

Orthostatic heart rate and Orthostatic intolerance

What does droxidopa help with?

Hypovolemia and Orthostatic intolerance

Methylphenidate helps with what three things?

Presyncope, Orthostatic palpation and fatigue

SSRI reduces and improves what?

Venous pooling and Orthostatic intolerance

What is the most effective tx of pregnant POTS pt?

Non pharmacological tx