Cedars-Sinai investigators suggest it may be helpful to keep an eye on patients with underlying health issues after COVID-19 vaccination to monitor for post-vaccine POTS, a condition that causes an abnormal increase in heart rate after standing or sitting up.

A new research study from the Smidt Heart Institute at Cedars-Sinai aimed to understand the possible connection between COVID-19 vaccination and a difficult-to-diagnose heart condition called postural orthostatic tachycardia syndrome, or POTS

The study found that patients who were immunized with a COVID-19 mRNA vaccination and then went on to have new or exacerbated POTS all had preexisting conditions that can lead to a POTS diagnosis.

POTS is associated with nervous system dysfunction and causes an abnormal increase in heart rate after standing or sitting up. It used to affect primarily women of childbearing age. However, for POTS cases that developed during the COVID-19 pandemic, men were equally affected.

“We were surprised when all the patients in our small cohort already had conditions that could make them more likely to develop POTS even without vaccination, such as palpitations, fast heart rates, orthostatic intolerance, hypermobile joints, asthma, systemic lupus, fainting, and chronic abdominal pain,” says Peng-Sheng Chen, MD, the corresponding author of the study and an international expert on the condition who leads one of only a few specialty clinics on the syndrome in the nation, in a release. 

The observational study, published in Heart Rhythm and presented during the American Heart Association Scientific Sessions, analyzed data from 10 patients treated at the Cedars-Sinai multidisciplinary POTS clinic between July 2021 and June 2022. When provided guideline-directed care, all study participants reported an improvement in their POTS condition.

Although there is an association between POTS and COVID-19 vaccination, a previous study of patient data across the Cedars-Sinai Health System found that patients diagnosed with COVID-19 were five times more likely to develop the cardiac condition after infection than after vaccination.

“COVID-19 infection itself seems to be either causing or unmasking a startling amount of POTS or POTS-like conditions globally,” says Debbie L. Teodorescu, MD, a cardiology fellow at the Smidt Heart Institute and first author of the study, in a release. “In our cohort, most patients responded well to treatment, but a subsequent COVID-19 infection tended to bring significant setbacks in recovery. That is why we urge all patients to be meticulous about avoiding COVID-19.”

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