6536 POTS & long covid

Objectives Although there is awareness of POTS (postural orthostatic tachycardia syndrome) symptoms in some patients with long covid there is not much information on how this impacts in children. We wanted to look at clinical presentation, management and outcomes in children with long covid who developed POTS Methods We looked at the retrospective clinical data of 15 children who presented with POTS like symptoms who also had long covid. These patients had a diagnosis of long covid and were subsequently diagnosed with POTS either following a head up tilt test or the active stand test. We looked at their clinical presentation, management and progress over the course of their follow up. Results Between January 2021- June 2023, 15 cases were seen by the local PEC (paediatrician with expertise in cardiology) at Bedford and were included in this study. This was comprised of 12 females & 3 males between the ages of 13–17years. They already had a diagnosis of long covid as per their treating paediatrician or long covid clinic and were referred for suspected POTS. All patients had prominent symptoms of dizziness and pre syncope. Palpitations were noted in 10 of the 15 patients (66%). Other symptoms described were breathlessness, brain fog or concentration difficulties which could all be part of their long covid symptoms as well. School attendance was reduced in about 80% of these patients. The diagnosis was confirmed with tilt test in 9 and active stand test in 6 patients. Management included reconditioning exercises along with medications like midodrine, Bisoprolol & ivabradine. 12 of the 15 patients received input from psychologists during the course of their treatment. Of the 15 patients all patients reported improvement in their dizziness and presyncopal symptoms on follow up. Fatigue, headache and gastrointestinal symptoms continued to be problematic in these patients. There was improvement in school attendance percentages in 8 of the 15 patients with the rest struggling because of their fatigue and nausea symptoms. Conclusion Some of the children with long covid also have symptoms of POTS which needs awareness amongst paediatricians. With a holistic management strategy there is often an amelioration of some of the symptoms of POTS that they present with. More research and long term follow up would be useful to understand these conditions and their long term impact