POTS following COVID-19 vaccination
Postural orthostatic tachycardia syndrome has not only occurred as a part of the “long COVID” syndrome following SARS-CoV-2 infection but has also been reported after COVID-19 vaccination. However, the incidence rate is multiple times higher after infection than after vaccination[44, 45]. POTS is among the wide range of cardiovascular and neurological complications imposed by SARS-CoV-2 vaccination[5-7, 46].
Previously POTS had been rarely reported following vaccination, except for HPV vaccination[47-49]. With the introduction of SARS-CoV-2 vaccines, the reported cases of new-onset POTS have increased[45, 50]. Most cases of vaccine-associated POTS occurred within one month of receiving COVID vaccines. Vaccine-induced phenomena are usually of autoimmune origin; thus, autoimmunity is the most probable explanation for this autonomic dysfunction disorder following SARS-CoV-2 vaccination. The vaccine is believed to trigger. This results from molecular mimicry between certain vaccine components and human proteins in the above receptors [51, 52]. Besides POTS, other autonomic dysfunctions caused by SARS-CoV-2 include sympathetic adrenergic and postganglionic sympathetic pseudomotor dysfunction[53, 54]. This COVID vaccine-related adverse event has been more reported after receiving mRNA vaccines, compared with other vaccine platforms[55-57]. Management of vaccine-related POTS is the same as the one due to other causes; however, its autoimmune origin suggests that unresponsive cases can be successfully treated with intravenous immunoglobulin (IVIG)[58].