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Related Experiment Video

Updated: May 7, 2025

Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance
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Association Between COVID-19 and Orthostatic Intolerance in Children: A Retrospective Study.

Bahram Kakavand1, Safia Centner2, Aliya Centner2

  • 1Pediatric Cardiology, Nemours Children's Health System, Orlando, USA.

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|January 1, 2025
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Summary

Post-COVID-19 infection or vaccination can cause persistent orthostatic intolerance (OI) and POTS in children. This study found POTS and autonomic dysfunction in pediatric patients, highlighting the need for awareness and research.

Keywords:
covid-19covid-19 vaccinelong-covidorthostatic intolerancepostural orthostatic tachycardia syndrome (pots)pots covid-19pots covid-19 vaccine

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Area of Science:

  • Pediatric Autonomic Neurology
  • Infectious Disease Immunology
  • Cardiology

Background:

  • Persistent symptoms like orthostatic intolerance (OI) and POTS are increasingly reported after COVID-19 infection and vaccination.
  • Postural Orthostatic Tachycardia Syndrome (POTS) significantly impairs quality of life due to excessive tachycardia and other symptoms upon standing.
  • Autonomic dysfunction following SARS-CoV-2 is a growing concern in pediatric populations.

Purpose of the Study:

  • To evaluate clinical and laboratory findings in pediatric patients experiencing OI and POTS after COVID-19 infection or vaccination.
  • To assess autonomic function using standardized tests in this cohort.
  • To investigate the prevalence of POTS and related autonomic abnormalities post-COVID-19.

Main Methods:

  • Retrospective chart review of pediatric patients (<18 years) with chronic dizziness or syncope post-COVID-19.
  • Autonomic function testing including tilt table, Valsalva maneuver, deep breathing test, and QSART.
  • Analysis of clinical symptoms, autonomic test results, and sweat production.

Main Results:

  • 16 pediatric patients (mean age 15) were studied; 14 post-infection, 2 post-vaccination.
  • 10 patients (62.5%) met POTS criteria, with average 49 bpm heart rate increase on tilt table.
  • Abnormal Valsalva (43.75%) and small fiber neuropathy on QSART (50%) were observed; elevated norepinephrine levels noted.

Conclusions:

  • COVID-19 infection and vaccination are linked to POTS and OI in children.
  • Findings support a connection between SARS-CoV-2 and pediatric autonomic dysfunction.
  • Further research on Long-COVID's long-term autonomic effects in children is crucial.