Researchers at Imperial College London explored how standing palpitations occur in long‑term COVID and offered guidance for diagnosis and management. The study appeared in a respected medical journal and contributes to a growing understanding of post‑COVID conditions in adults across North America’s healthcare systems.
Long COVID refers to symptoms that persist beyond four weeks after initial recovery from acute infection. The clinical picture is diverse, ranging from fatigue and headaches to shortness of breath and cognitive changes. Among the less common but important signs is orthostatic tachycardia, a condition marked by a rapid heartbeat when a person is upright or standing, typically defined as a rise of more than about 30 beats per minute from the resting rate.
Researchers emphasised that the surge in heart rate on standing is largely tied to the body’s transition to an upright posture rather than to exertion. Patients may also report sensations described as electric shocks or a feeling of electricity coursing through the body. A key diagnostic criterion used in many clinical settings is persistent symptoms for more than three months, though this timeline can vary with clinical judgment and regional guidelines.
In approaching suspected orthostatic tachycardia, clinicians are advised to rule out alternative conditions that could mimic the symptoms. This includes ensuring adequate hydration, evaluating for infections or sepsis if clinically indicated, and checking for anemia, thyroid disorders, and heart‑related diseases. A comprehensive assessment helps distinguish orthostatic tachycardia from other cardiovascular or systemic illnesses, enabling safer and more targeted care.
Management strategies emphasised by the researchers focus on practical, day‑to‑day changes. Adequate fluid intake, a balanced level of physical activity, sufficient sleep, and the use of compression garments are commonly recommended. Patients are advised to identify and avoid triggers that can worsen symptoms, such as heat, prolonged standing, excessive alcohol consumption, and heavy meals. Dietary adjustments aimed at reducing bloating and supporting gut health may also play a role in improving overall well‑being and comfort during daily activities.
When lifestyle measures alone do not lead to improvement, clinicians may consider pharmacologic options. The decision to use medications is individualized, taking into account the patient’s symptom profile, comorbidities, and potential side effects. Beyond medication, a holistic approach that includes education about pacing activities, stress management, and gradual reconditioning can help patients regain function and quality of life over time.
Orthostatic tachycardia is thought to stem from dysfunction of the autonomic nervous system, which governs unconscious bodily processes such as heart rate and blood pressure. It tends to affect younger individuals and is more common in women. Several risk factors have been proposed, including a suppressed immune system, higher body mass index, and elevated blood pressure, though research continues to clarify these associations. In the United States and Canada, clinicians are increasingly recognizing the condition as part of the broader spectrum of post‑acute sequelae of SARS‑CoV‑2 infection, leading to more standardized evaluation and management approaches across primary care and specialty clinics.