Patients with long covid—defined by the National Institute for Health and Care Excellence (NICE) as signs and symptoms that persist for more than four weeks (and especially more than 12 weeks) following acute covid-1912—may present in primary care with symptoms of palpitations (tachycardia) triggered by standing or minimal exertion.3 These may be accompanied by dizziness, breathlessness, chest pain, sweating, bloating, fatigue, and other symptoms which may be caused by a dysfunction of the autonomic nervous system (dysautonomia).45678910111213 Patients can find these symptoms debilitating and they can affect function and mood. Limited evidence, variable diagnostic criteria, uncertainty around cause and pathogenesis, and the absence of licensed medications, have all contributed to making this a difficult condition to diagnose and manage. In this practice pointer, we offer an overview of orthostatic tachycardia following covid-19, including a summary of the key steps for diagnosis and management.

Prevalence estimates vary depending on sample and setting, but indicate that about 25% of long covid patients may have dysautonomia14 and 2-14% will develop orthostatic tachycardia (postural orthostatic tachycardia syndrome) six to eight months after infection.341516Box 1 provides more information on these conditions. The assessment and management is summarised in the infographic.

Box 1

Dysautonomia and postural orthostatic tachycardia syndromes

The autonomic nervous system is responsible for the unconscious regulation of many physiological processes, including heart rate, blood pressure, respiration, and digestion. The broad category of “dysautonomia” encompasses several conditions, from the intermittent “faint” (neurocardiogenic syncope) through more pervasive dysregulation (postural …


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