This case report suggests a potential paradoxical improvement in hyperadrenergic POTS symptoms and catecholamine levels following COVID-19 infection.
May warrant caution with combined ivabradine-beta blockade post-viral illness; leaves open whether COVID-19 can normalize catecholamines in hyperadrenergic POTS.
A 32-year-old woman with a history of symptomatic supraventricular tachycardia, inappropriate sinus tachycardia, and hyperadrenergic POTS was treated with ivabradine and metoprolol. She then presented with bradycardia and Mobitz II second-degree AV block on event monitoring six weeks after COVID-19 infection. Her post-viral workup revealed normalization of catecholamine levels and significant symptomatic improvement in heart rate. To the authors' knowledge, this is the first reported case of improvement in POTS after COVID-19 infection. As our understanding of COVID-19 continues to improve, it will be vital to better understand the impact of COVID-19 dysautonomia on cardiac patients.
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Ocher et al. (2021) studied this question.
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