Persistence of symptoms beyond acute coronavirus disease 2019 (COVID-19) is termed post-acute sequelae of SARS-CoV-2 (PASC) and include neurological, pulmonary, cardiac, psychiatric, and functional impairment. Most common cardiac sequelae appear to be postural orthostatic tachycardia syndrome (POTS). The incidence, presentation and long-term outcomes of POTS as a post-COVID condition is unknown.


      To study the presentation, management, and outcome of Post-COVID POTS.


      We conducted a retrospective study of all patients who were diagnosed with POTS at Cardiology, Neurology, and Rehabilitation Post-COVID clinic after COVID-19 infection between March 1, 2020, and November 1, 2021, at the University of Texas Health San Antonio. We examined COVID history, POTS diagnosis, management, and outcomes of Post-COVID POTS patients.


      The cohort comprised of 40 patients who were diagnosed with Post-COVID POTS. Mean age was 40.98 ± 11 years with a mean BMI of 32.32 ± 9.70. Females comprised of 97.5% of the patients. Symptoms began 4-6 weeks after COVID and included fatigue (75%), palpitations (70%), lightheadedness (47.5%), cognitive decline (50%), mental clouding (50%), dyspnea (50%), memory loss (47.5%), and syncope (2.5%). Patients were diagnosed with Post-COVID POTS an average of 219.9 ± 156.4 days after the diagnosis of COVID-19. Tachycardia upon standing or activity occurred with a mean change in heart rate of 42.48 ± 29.37 bpm. Along with increasing water intake, salt intake, rehabilitation, and lower body compression, initial management included beta blockers (30%), fludrocortisone (5%), and midodrine (5%). At 6 months, patients still had persistent symptoms with 65.52% of patients noting some improvement, 31.0% with stable symptoms, and 3.45% with worsening symptoms. Physical therapy and rehabilitation were reported as the most effective treatment in the mild improvement group. At 6 months disabling symptoms persisted in 100% of these high functioning women pre-COVID. No patient had full recovery.


      Post-COVID POTS is a disabling diagnosis and symptoms persisted even after 6 months of onset. Although physical therapy and rehabilitation seem to have some effect, these patients who were functional pre-COVID are still disabled and none had full recovery.