PEM and POTS in Long COVID: What you need to know as a healthcare provider
People with Long COVID frequently experience the symptom clusters PEM (post-exertional malaise) and POTS (postural orthostatic tachycardia syndrome). Doctors from the Platform for Doctors with Post-Acute Infectious Diseases Netherlands (PAN) and members of the C-Support medical team have written an important article on this topic. The article provides a clear overview of the symptoms, causes, diagnosis, and treatment of these conditions.
Why is this important?
In the Netherlands, approximately 450.000 people experience long-term symptoms after a COVID-19 infection. A large proportion of them experience PEM and/or POTS. These symptoms often go unrecognized, causing patients to go unnecessarily long without appropriate help.
What is PEM?
PEM means that symptoms such as fatigue, pain, and difficulty concentrating worsen after cognitive, emotional, or physical exertion. Even light activities like showering or dressing can be overwhelming. Sensory overload (light and sound) can also cause PEM. PEM can develop shortly after exertion, but often occurs with a delay, sometimes even up to 72 hours. This makes it difficult for both patients and caregivers to recognize. Typically, there is a period of recovery within days to weeks, but not always back to the previous level. Therefore, there is a risk of gradual deterioration with repeated overload.
What is POTS?
POTS is a condition in which the heart rate increases abnormally when standing or sitting upright, while blood pressure remains stable. This can lead to dizziness, palpitations, shortness of breath, and other symptoms. The symptoms worsen with prolonged upright posture, can be frightening and significantly disabling, and can lead to bedridden patients.
Practical tools for healthcare providers
The article gives clear advice for:
- recognizing PEM and POTS;
- making the correct diagnosis, for example with the NASA Lean Test;
- guiding patients, with attention to lifestyle, pacing and medication;
- preventing harm in patients with PEM.
PEM and POTS are severely disabling symptoms that often occur with Long COVID. Early recognition and proper support can significantly improve patients' daily functioning and quality of life.
