Dysautonomia

The autonomic nervous system (ANS) operates in the background of every bodily function. It regulates heart rate, blood pressure, digestion, temperature, and breathing without conscious effort. In Long COVID, this system frequently becomes dysregulated, a condition broadly called dysautonomia. The most common presentation is Postural Orthostatic Tachycardia Syndrome (POTS), where heart rate spikes excessively upon standing. But dysautonomia can also manifest as blood pressure instability, temperature swings, abnormal sweating, and chronic digestive dysfunction.

The mechanism behind post-COVID dysautonomia appears to involve multiple overlapping pathways. SARS-CoV-2 may directly damage autonomic nerve fibers, trigger autoantibodies that target autonomic receptors, or sustain chronic inflammation that disrupts signaling between the brainstem and peripheral organs. The vagus nerve, which carries roughly 80% of parasympathetic signaling in the body, is a frequent target. When vagal tone drops, the sympathetic “fight or flight” system dominates, producing the racing heart, adrenaline surges, and energy crashes that many Long COVID patients describe.

Treatment strategies for dysautonomia focus on restoring autonomic balance through multiple angles. These may include autonomic reconditioning (gradual exercise protocols), salt and fluid loading to support blood volume, vagus nerve stimulation to improve parasympathetic tone, and targeted supplementation to reduce neuroinflammation. Dr. Groysman evaluates each patient’s autonomic profile individually, because dysautonomia in Long COVID rarely has a single cause. Addressing the underlying drivers, whether autoimmune, inflammatory, or structural, is essential for meaningful recovery.