Treatment of long COVID complicated by postural orthostatic tachycardia syndrome

Purpose The coronavirus disease sequelae, known as long coronavirus disease may present with various symptoms. Among these symptoms, autonomic dysregulation, especially postural orthostatic tachycardia syndrome, should be evaluated. This study aimed to investigate the treatment course of long coronavirus disease, with postural orthostatic tachycardia syndrome.Methods The medical records of patients who complained of fatigue and met the criteria for postural orthostatic tachycardia syndrome diagnosis were reviewed. Change in heart rate fatigue score, and employment/education status at the initial and last visits were evaluated.Results Thirty-two patients with long coronavirus disease complicated by postural orthostatic tachycardia syndrome were followed up (16 male and 16 female; median age: 28 years). Three patients had acute-phase pneumonia. The follow-up period was 159 days, and the interval between coronavirus disease onset and initial hospital attendance was 97 days. Some patients responded to beta-blocker therapy. Many patients had psychiatric symptoms that required psychiatric intervention and selective serotonin reuptake inhibitor prescription. Difference in heart rate and performance status, and employment/education status improved from the first to the last clinic visit. Postural orthostatic tachycardia syndrome after severe acute respiratory syndrome coronavirus 2 infection could be treated faster than the syndrome occurring in isolation. This was thought to be due to the effects of various treatment interventions and spontaneous improvements after severe acute respiratory syndrome coronavirus 2 infection.Conclusion Postural orthostatic tachycardia syndrome evaluation must be considered when patients with symptoms of coronavirus disease complain of fatigue.