POTS and Long Covid
What is POTS?
Also known as Postural Orthostatic Tachycardia Syndrome. POTS is condition where a person's heart rate significantly increases when changing positions from lying down, sitting and standing. This rapid heartbeat is often accompanied by symptoms such as dizziness, lightheadedness, fainting, shortness of breath, exercise intolerance, brain fog, muscle weakness, gastrointestinal issues, and fatigue. POTS is part of a group of disorders known as dysautonomia, in which the autonomic nervous system (ANS) does not function as it should. The ANS is responsible for involuntary functions in the body such as heart rate, blood pressure, digestion and temperature regulation.
The cause of POTS is not well-understood. It often correlates with trauma, traumatic injury, surgery or viral illnesses.
Common comorbidities of POTS are: mast cell activation syndrome (MCAS), Ehlers-Danlos syndrome, conditions such as Sjögren syndrome, Hashimoto thyroiditis, rheumatoid arthritis, and celiac disease. (Ormiston et. al 2022)
Long Covid & POTS
Long Covid is a term used to describe the lingering presence of various symptoms, weeks or months after a SARS-CoV-2 infection irrespective of the viral status. It can be continuous, relapsing or remitting. There might still be be the persistence acute COVID symptoms or entirely new symptoms. Majority of those with Long COVID are PCR negative, indicating that the presence of the virus is no longer in the system. Long Covid can also be thought of as the time lag between the microbiological recovery and clinical recovery. (Raveendran et. al 2021)
POTS is now more commonly seen and discussed because similar symptoms are seen in many people with Long Covid. Dysregulation of the ANS that occurs in POTS suggests that Long Covid can either trigger or exacerbate the condition.
Orthostatic intolerance and other autonomic dysfunction syndromes are increasingly recognized as distinct symptom clusters in Long Covid. These conditions are frequently accompanied by widespread symptoms such as fatigue, malaise, and skin rashes, which may indicate a broader issue with immune regulation. Additionally, the presence of multiple autoantibodies in both Covid-related and non-Covid autonomic disorders suggests a potential underlying autoimmune pathology. (El-Rhermoul et. al 2023)
Acupuncture and POTS
Acupuncture is just one branch of Chinese Medicine. Because Chinese Medicine has a long and vast history, it also gives us an infinite number of ways to look at an imbalance in the body and multiple ways to address it. Acupuncture also has a strong ability to calm the nervous system and interrupt its flight or flight response. This is extremely promising for those who are having an over reaction in their nervous system that might be causing their POTS or Long Covid symptoms. Acupuncture is known for its ability to improve blood circulation, reduce pain and affect the brain and nervous system.
The hypothalamus, a part of the brain, plays an important role in controlling the ANS. When Electro Acupuncture (EA) is applied, it influences the hypothalamus to adjust autonomic functions, such as the release of nitric oxide in response to increased sympathetic activity, such as high blood pressure. Studies have shown that EA, particularly at the ST36 acupuncture point, can effectively modulate neuronal nitric oxide synthase activity in the hypothalamus, impacting both the sympathetic and parasympathetic nervous systems, as well as endocrine function. (Li, et. al 2013). One should note that this study was done in order to determine how acupuncture works on the nervous system. EA is not appropriate for many sensitive patients, especially those who might have difficulty regulating heart rate or blood pressure such as those with POTS.
In Chinese Medicine, common patterns that are seen in POTS and Long Covid patients are extreme deficiencies of Qi and Blood with Blood stagnation. In those with POTS, there is often seen, an inability to circulate blood throughout the body at the proper rate which is why heart rate and blood pressure symptoms arise. These deficiencies seem to show up in the upper jiao or chest region or more specifically, the Heart and Liver systems in Chinese Medicine. Because the Heart Qi is weak, it is difficult for circulation to get to where it needs to, for example to the head and brain causing brain fog, headaches or dizziness. Or to the digestive system causing bloating and constipation. The heart is working too hard which causes changes in heart rate and blood pressure. Because the Liver Qi is too weak, the body struggles to regulate stressors and instead, the nervous system is prone to overreacting which further weakens the Qi dynamic. This overreaction of Liver Qi is seen in the dysregulation of autonomic nervous system. Regulation of the heart, circulation of blood and digestive processes are things that should occur on their own without having to give much thought about it. The fact that these systems are having trouble self-regulating are signs of dysfunction in the nervous system. Here the body must work harder which continues to deplete the Liver Qi showing up as fatigue, exhaustion, inability to sleep despite being tired, poor digestion, achy and weak muscles, mental fatigue.
With the understanding of how this occurs in Chinese Medicine, many acupuncturists are equipped to help POTS and Long Covid patients to rebalance their system. Depending on your situation and severity one should expect to have weekly or in some cases twice weekly visits for the first month or so of beginning acupuncture. Acupuncture is a natural treatment and consistent treatment allows your body to hold onto effects of each subsequent treatment until it can begin to be in balance on its own.
Please note that I am a Doctor of Acupuncture and Chinese Medicine and not a Medical Doctor. If you are experiencing POTS or Long Covid please be sure that you are being managed by a medical doctor in order to also engage in acupuncture or other modalities. This post is educational only and not medical advice. Chinese Medicine is applied in many different ways depending on an individual’s unique situation.
You might also like reading: 5 Benefits of Astragalus, Should I Be Worried About Long Covid?, 5 Benefits of Echinacea, 5 Signs You Have Lowered Immunity
Written by Dr. Emily Siy, DACM on 9/16/24
Sources:
El-Rhermoul, F-Z., Fedorowski, A., Eardley, P., Taraborrelli, P., Panagopoulos, D., Sutton, R., Lim, PB., Dani, M., Autoimmunity in Long Covid and POTS, Oxford Open Immunology, Volume 4, Issue 1, 2023, iqad002
Li., Q-Q., Shi, G-X., Xu, Q., Wang, J., Liu, C-Z., Wang, L-P., (2013) Acupuncture Effect and Central Autonomic Regulation Evidence-Based Complementary and Alternative Medicine May 26
Ormiston, C.K., Świątkiewicz, I., Taub, P.R., (2022) Postural orthostatic tachycardia syndrome as a sequela of COVID-19 Heart Rhythm Volume 19, Issue 11, November 2022, Pages 1880-1889
Raveendran, A.V., Jayadevan, R., Sashidharan, S. (2021) Long COVID: An Overview Diabetes & Metabolic Syndrome: Clinical Research & Reviews Vol 15, Issue 3 May-June pp 869-975