Post-COVID Heart Issues: Rapid Heart Rate After Recovery

Post-COVID heart complications?

Dear Dr.
Wu,
I was diagnosed and recovered from COVID-19 on September 2nd.
Since mid-October, I have been experiencing a resting heart rate of 80-100 beats per minute while sitting, but it increases to over 100 beats per minute when I stand, sometimes reaching as high as 120.
I have undergone several tests at Taipei Medical University, including 1.
an electrocardiogram (ECG), 2.
an echocardiogram, and 3.
a 24-hour Holter monitor.
I have also visited the emergency department multiple times for cardiac enzyme blood tests, X-rays, and consultations with a neurologist.
Additionally, I had a carotid ultrasound and thyroid antibody tests, which only indicated mild mitral valve prolapse.
I was hospitalized at Taipei Medical University for five days, but the cause of my symptoms remains undetermined.
Currently, I am taking a medication called Inderal LA (propranolol) to help control my heart rate, but the underlying reason for my heart rate spike upon standing has not been identified.
I kindly seek your guidance on further steps I can take to investigate the cause of my condition.
I greatly appreciate your assistance.
Sincerely,
Doctor Q&A Teams

Miss Jian, 40~49 year old female. Ask Date: 2022/11/16

Dr. Wu Xueming reply Cardiology

If your palpitations are still severe, it is recommended to undergo a 24-hour Holter monitor to check for any arrhythmias.

Reply Date: 2022/11/16

More Info

Post-COVID heart issues, particularly rapid heart rate or tachycardia, have become increasingly recognized as potential complications following recovery from COVID-19. Your experience of a heart rate that spikes significantly upon standing is known as orthostatic tachycardia, which can be a manifestation of dysautonomia—a condition where the autonomic nervous system does not function properly. This can occur after viral infections, including COVID-19.

The autonomic nervous system regulates involuntary bodily functions, including heart rate, blood pressure, and digestion. After a viral infection, some individuals may experience a dysregulation of this system, leading to symptoms such as rapid heart rate, lightheadedness, and fatigue, especially upon standing. This phenomenon is sometimes referred to as Postural Orthostatic Tachycardia Syndrome (POTS).

Your thorough investigations, including echocardiograms, EKGs, and blood tests, have ruled out many serious conditions, which is reassuring. The presence of mild mitral valve prolapse is common and often does not lead to significant issues, but it can sometimes contribute to palpitations or changes in heart rate.
Given that you have already undergone extensive testing without a definitive diagnosis, it may be beneficial to consider the following steps:
1. Autonomic Function Testing: If not already performed, specialized tests can assess how well your autonomic nervous system is functioning. This may include tilt table testing or other evaluations that measure heart rate and blood pressure responses to changes in posture.

2. Lifestyle Modifications: Increasing fluid and salt intake (if not contraindicated by other health conditions) can help expand blood volume and improve symptoms. Regular, gentle exercise can also help improve autonomic regulation over time.

3. Medication Review: Discuss with your healthcare provider the medications you are currently taking, including the use of beta-blockers like Inderal (propranolol) or other medications that may help manage heart rate. It's essential to ensure that any medications you are taking do not interact adversely with each other.

4. Follow-Up with Specialists: If your symptoms persist, consider seeking a referral to a cardiologist who specializes in post-viral syndromes or dysautonomia. They may have additional insights or treatment options that could be beneficial.

5. Monitoring and Support: Keep a detailed log of your symptoms, including heart rate measurements, activities, and any triggers you notice. This information can be invaluable for your healthcare team in understanding your condition better.

6. Mental Health Considerations: The stress and anxiety that can accompany ongoing health issues should not be overlooked. Engaging in stress-reduction techniques such as mindfulness, yoga, or counseling may help alleviate some symptoms.

In summary, while the rapid heart rate you are experiencing post-COVID can be concerning, it is essential to approach this condition holistically. With the right support and management strategies, many individuals find improvement in their symptoms over time. Continue to advocate for your health, and do not hesitate to seek further evaluations if your symptoms do not improve.

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