COVID-19 Vaccination Might Induce Postural Orthostatic Tachycardia Syndrome: A Case Report

Abstract

We report a case of new-onset postural orthostatic tachycardia syndrome in a healthy 46-year-old female after a single dose of the BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 vaccine. There have been three prior reports of new-onset postural orthostatic tachycardia syndrome after COVID-19 vaccination. Predominant symptoms noted included fatigue, brain fog, headache, sinus tachycardia, and dizziness. Management includes noninvasive therapies, behavioral approaches, and pharmacologic regimens. Here, the patient presented with fatigue, palpitations, dizziness, and presyncope, with symptoms beginning 7 days after vaccination. Presenting vitals included temperature within normal limits, inappropriate tachycardia, up to 120 beats per minute, blood pressure of 128/87 mm of mercury, and 100% saturation in room air. Her management included lifestyle changes, dietary supplements, and ivabradine. Further studies are needed to evaluate prevalence, etiology, and optimal management.

Suspected COVID-19 mRNA Vaccine-Induced Postural Orthostatic Tachycardia Syndrome

“…POTS has been described following both mRNA-based Moderna COVID-19 and Pfizer-BioNTech COVID-19 vaccines [5][6][7][8]. Interestingly, the cases associated with the latter usually occur one to three weeks postinoculation, a similar time frame to our patient.…”

“…Autonomic dysfunction has been reported following infection with COVID-19 [3,4]. Additionally, there have been a few case reports of dysautonomia occurring in patients following vaccination, including postural orthostatic tachycardia syndrome (POTS) and a case of inappropriate sinus tachycardia (IST) [5][6][7][8][9].…”

Post-acute sequelae of SARS-CoV-2 syndrome presenting as postural orthostatic tachycardia syndrome

“…We found three case reports of POTS after COVID-19 vaccination. Hermel et al [ 25 ] reported a previously healthy 46-year-old female patient who developed POTS symptoms after a single dose of BNT162b2 SARS-CoV-2 vaccine from Pfizer. Her predominant symptoms included fatigue, brain fog, headache, sinus tachycardia, and dizziness.…”

Overlapping Myocarditis and Postural Orthostatic Tachycardia Syndrome After COVID-19 Messenger RNA Vaccination: A Case Report

“…However, POTS can be precipitated by immunologic stressors such as viral infection or vaccination [3]. Notably, reports of adult cases of new-onset POTS after COVID-19 mRNA vaccination have been emerging [12][13][14][15]. Although the exact mechanism of vaccine-induced POTS is not clear, the autoimmune pathophysiology might be a key component [13][14][15].…”