Can a viral infection be followed by dysautonomia?

References and level of evidence

1. Dani M et al. Autonomic dysfunction in 'long COVID': rationale, physiology and management strategies. Clinical Medicine, 21(1):e63–e67 2021. DOI: 10.7861/clinmed.2020-0896. PMID: 33243837.(expert opinion)
   Limitations: Early-pandemic data; proposed mechanisms; few controlled studies at the time of publication. Population: narrative review of autonomic dysfunction and long COVID. Read: abstract and excerpts of the text.
   Declared conflicts of interest: Not reviewed in the part of the source that was read
2. Shouman K et al. Autonomic dysfunction following COVID-19 infection: an early experience. Clinical Autonomic Research, 31(3):385–394 2021. DOI: 10.1007/s10286-021-00803-8. PMID: 33860871.(observational study)
   Limitations: Small tertiary-center sample; referral bias; causation not established. Population: retrospective series of 27 referred patients. Read: abstract.
   Declared conflicts of interest: Not reviewed in the part of the source that was read
3. Vernino S et al. Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 NIH Expert Consensus Meeting — Part 1. Autonomic Neuroscience, 235:102828 2021. DOI: 10.1016/j.autneu.2021.102828. PMID: 34144933.(guideline or consensus)
   Limitations: Consensus and narrative review; not a causal trial on infections. Population: NIH consensus, state of the science on POTS. Read: full text.
   Declared conflicts of interest: Competing interests declared individually in the article (consulting, grants, patents).
4. Schondorf R, Low PA. Idiopathic postural orthostatic tachycardia syndrome (POTS): an attenuated form of acute pandysautonomia?. Neurology, 43(1 Pt 1):132–137 1993. DOI: 10.1212/WNL.43.1_Part_1.132. PMID: 8423877.(exploratory finding)
   Limitations: Older study, small sample, retrospective history. Population: small exploratory clinical cohort with POTS. Read: abstract.
   Declared conflicts of interest: Not reviewed in the part of the source that was read
5. Sandroni P et al. Postural tachycardia syndrome: clinical features and follow-up study. Mayo Clinic Proceedings, 74(11):1106–1110 1999. DOI: 10.4065/74.11.1106. PMID: 10560597.(observational study)
   Limitations: Clinical selection; incomplete, retrospective follow-up. Population: clinical POTS cohort with follow-up of a subgroup. Read: abstract.
   Declared conflicts of interest: Not reviewed in the part of the source that was read
6. Schoene D et al. Neurocardiac Autonomic Dysfunction in Patients With Post-COVID-19 Condition: A Systematic Review and Meta-Analysis. European Journal of Neurology, 33(3):e70561 2026. DOI: 10.1111/ene.70561. PMID: 41814525.(evidence synthesis)
   Limitations: 9 of 11 studies at high risk of bias; heterogeneity; literature search ended in September 2023. Population: 11 observational studies, 593 people with post-COVID-19 condition and 565 controls. Read: abstract.
   Declared conflicts of interest: Not reviewed in the part of the source that was read
7. Wang C et al. The prevalence of orthostatic intolerance, postural orthostatic tachycardia syndrome and orthostatic hypotension in post-acute sequelae of COVID-19. Frontiers in Cardiovascular Medicine, 12:1679252 2025. DOI: 10.3389/fcvm.2025.1679252. PMID: 41584279.(evidence synthesis)
   Limitations: After correction for publication bias (trim-and-fill), the POTS estimate falls from 36.2% to 8.7%. Very high heterogeneity for POTS; publication bias; very low GRADE certainty; heterogeneous definitions. Population: meta-analysis of observational PASC studies. Read: full text (Frontiers).
   Declared conflicts of interest: No commercial or financial relationships declared; funding: Hebei Provincial Administration of Traditional Chinese Medicine
8. Haute Autorité de santé. Parcours de soins de l'adulte avec des symptômes prolongés de la Covid-19. HAS (French National Authority for Health), care pathway guide, approved April 11, 2024 2024.(guideline or consensus)
   Limitations: Does not cover all POTS that is not post-COVID; post-COVID care pathway guide. Population: adults and adolescents aged 15 or older with prolonged post-COVID symptoms. Read: full text.
   Declared conflicts of interest: The working group's public declarations of interest were reviewed by HAS and judged compatible
9. NICE, SIGN, RCGP. COVID-19 rapid guideline: managing the long-term effects of COVID-19 (NG188). NICE 2020.(guideline or consensus)
   Limitations: General guideline on long COVID; not a stand-alone guideline for the diagnosis or treatment of POTS. Population: adults and children with prolonged symptoms after COVID-19. Read: overview page (update of November 11, 2021).
   Declared conflicts of interest: Not reviewed in the part of the source that was read
10. NICE. Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management (NG206). NICE guideline 2021.(guideline or consensus)
    Limitations: Not a POTS guideline; useful only for ME/CFS and the associated post-exertional malaise. Population: children, young people and adults with suspected or diagnosed ME/CFS. Read: online recommendations (nice.org.uk), published October 29, 2021.
    Declared conflicts of interest: Institutional document; group declarations according to NICE procedures
11. Sivakoti K, Cortez MM, Fedorowski A, Fudim M, Lau DH, Novak P, Rowe PC, Schofield JR, Blitshteyn S, International POTS and Dysautonomia Expert Panel. Postural orthostatic tachycardia syndrome (POTS) and dysautonomia: International multidisciplinary expert consensus. American Journal of Medicine 2026. DOI: 10.1016/j.amjmed.2026.08.012. PMID: 42665152.(guideline or consensus)
    Limitations: Expert consensus; does not replace clinical studies or comparative trials. Population: international Delphi consensus, adults and pediatrics, POTS and non-POTS dysautonomia. Read: abstract.
    Declared conflicts of interest: Not visible in the abstract consulted