When the Heart Won’t Settle: Heart Symptoms in Long Covid
Nicola Williams, Cardiology Nurse
Nicola Williams is a cardiology nurse specialising in heart rhythm conditions and autonomic disorders. She works closely with patients experiencing Postural Tachycardia Syndrome (PoTS) and post-viral cardiovascular symptoms. We are sharing this blog as part of Long Covid Awareness Day, whose theme this year is Every Heartbeat Counts.
Over the past few years, many people recovering from COVID-19 have found that the illness does not always end when the infection clears. For some, symptoms have continued for months or even years. This condition, commonly known as Long Covid, can affect multiple parts of the body. For many people, the heart and circulation are part of that story.
As a cardiology nurse specialising in heart rhythm conditions, I have seen first-hand how COVID-19 has changed the landscape of heart health. Increasingly, patients present with symptoms such as palpitations, dizziness, chest discomfort, breathlessness, and overwhelming fatigue. Often, their initial tests appear normal, yet their symptoms are very real. For many people, these symptoms can significantly affect daily life, making even simple activities such as standing, walking, or concentrating much more difficult than before.
Understanding how Long Covid can affect the heart and circulation is an important step towards better support, better care, and ultimately better recovery. Recognising what may be happening in the body can help people living with Long Covid make sense of symptoms that often feel confusing or difficult to explain.
What I see in clinic
In clinic, I often meet people who say the same thing: “My tests are normal, but I still don’t feel like myself.”
Many individuals describe a racing heart when they stand up, dizziness when they try to do everyday tasks, or fatigue that feels very different from ordinary tiredness. Some have been told that everything looks fine, but they know something in their body has changed since their COVID infection.
These conversations are important. Listening to people’s experiences helps clinicians recognise patterns and consider conditions such as autonomic dysfunction or Postural Tachycardia Syndrome (PoTS). For many patients, simply being listened to and having their symptoms acknowledged can be an important first step towards understanding what is happening and finding ways to manage it.
The heart and the autonomic nervous system
One way Long Covid may affect the body is through the autonomic nervous system. This is the system that controls many automatic functions in the body, such as heart rate, blood pressure, digestion, and temperature regulation.
When this system does not work properly, people may experience symptoms such as:
Rapid heart rate
Palpitations
Dizziness or feeling light-headed
Difficulty tolerating exercise
Brain fog
Severe fatigue
For some people, these symptoms resemble PoTS. PoTS is a condition where the heart rate rises abnormally when a person moves from lying down or sitting to standing. It is a form of autonomic dysfunction and has long been recognised after viral illnesses. Although PoTS existed long before the COVID-19 pandemic, clinicians have reported a growing number of cases since COVID-19, particularly among people experiencing ongoing Long Covid symptoms.
Research suggests that autonomic dysfunction may play an important role in Long Covid, particularly in symptoms such as heart rate changes and dizziness when standing. Some studies have also found that a number of people with ongoing post-COVID symptoms meet the criteria for PoTS or similar conditions affecting the autonomic nervous system.
Why symptoms can be misunderstood
Many people with Long Covid describe a frustrating experience when seeking medical help. Tests such as ECGs, echocardiograms (heart scans), and blood tests may appear normal, yet symptoms continue.
This can sometimes lead to patients being told that “everything looks fine.”
But normal test results do not always mean that nothing is wrong.
Some conditions affect how the body regulates heart rate and blood flow, rather than the structure of the heart itself. These problems can be harder to detect with routine tests. Long Covid may involve changes in blood flow control, nervous system function, or inflammation that standard heart tests do not always pick up.
This is why awareness among healthcare professionals is so important. Recognising that symptoms such as palpitations, dizziness, and fatigue may have a physical cause can help guide the right assessment and support.
Protecting heart health during recovery
Recovery from Long Covid is rarely straightforward. Many people experience fluctuating symptoms, with good days and more challenging days. Supporting heart health during recovery often involves a combination of approaches.
These may include:
Pacing and energy management
Learning to balance activity and rest is important. Doing too much too quickly can worsen symptoms for some people living with Long COVID.
Hydration and salt intake
For people who feel dizzy or experience a rapid heart rate when standing, drinking more fluids and sometimes increasing salt intake may help support blood circulation.
Gentle, personalised activity
Some people benefit from slowly increasing activity levels as their symptoms allow. However, this should always be tailored to the individual, particularly for those who experience worsening symptoms after exertion.
Medical assessment when needed
Persistent palpitations, chest pain, or fainting should always be assessed by a healthcare professional. In some cases, referral to cardiology or specialist autonomic clinics may be helpful.
Listening to Patient Experience
One of the most important lessons Long Covid has taught the healthcare community is the importance of listening to patient experiences.
Many people living with Long Covid have become experts in their own condition. They often recognise patterns in their symptoms and understand what helps or worsens them. Their voices have played a vital role in raising awareness and encouraging research into the long-term effects of COVID-19.
Patient advocacy has highlighted an important reality: recovery from viral illness is not always simple or predictable, and symptoms affecting the heart and circulation deserve careful attention and understanding.
Looking Forward
Although there is still much to learn about Long Covid, understanding is growing quickly. Researchers continue to explore how viral infections can affect the heart, circulation, and autonomic nervous system. Encouragingly, research is also expanding into possible treatments and approaches that may help improve symptoms and quality of life for those living with Long Covid. At the same time, healthcare professionals are becoming more aware of the complex symptoms people may experience after COVID-19.
For those living with Long Covid, it is important to remember that you are not alone. Support organisations and patient communities are helping to improve awareness, encourage research, and provide valuable support to people navigating recovery.
Heart health is about more than the structure of the heart itself. It also involves the complex systems that control circulation, energy, and balance within the body. As our understanding of Long Covid continues to grow, so does our ability to recognise these challenges and work towards better care for those affected.
Importantly, progress is being made, driven by research, clinical experience, and the voices of people living with the condition every day.