FOSTERING RECOVERY: A CASE STUDY ON THE JOURNEY FROM UNCERTAINTY TO DIAGNOSIS IN POST-COVID POTS

Imagine, one day you are an active 20-year-old, then after a COVID-19 infection, your life is now limited by debilitating symptoms: fainting, palpitations, and exercise intolerance. Your whole world has changed, and you have no diagnosis and no treatment options. This was reality for a patient referred to cardiac rehabilitation in early 2023 as a unique case, not meeting usual service criteria. In the absence of a formal diagnosis, there was no clear pathway for treatment and no rehabilitation guidelines to follow. After a comprehensive assessment, marking the start of the road to recovery, a conservative and gradual approach to re-introducing exercise was developed, whereby progressions were only made when no symptoms were experienced during nor following the sessions. Across the next nine months, further symptoms were identified, prompting further research, which shaped a plausible diagnosis: Postural Orthostatic Tachycardia Syndrome (POTS). Whilst initially dismissed as a possibility by the patient’s cardiologist, after further questioning, gaining objective data and referral to specialist physicians, this plausible diagnosis was confirmed. Through months of rehabilitation, lifestyle modifications and commencing medication, this patient has improved symptom control and increased activity tolerance. Importantly, this has allowed return to studying, return to part time work and return to tolerating daily activities. As exercise physiologists, we often spend more time with patients than medical practitioners, and resultingly identify characteristics which may otherwise be missed in busy clinics. This case study acts as a reminder of the importance of trusting your instinct and not being afraid to advocate for patients - doing so may just re-direct them down the road to recovery. With the increasing prevalence of dysautonomia, particularly POTS, as consequences of COVID-19 infections, there is an ever-increasing need for awareness, in addition to clinician upskilling to ensure best support and management of these patients.