Kaleigh Levine was running drills in the gym with her lacrosse team at Notre Dame College in South Euclid, Ohio, when everything turned black.
“The coach wanted me to get back in the line, but I couldn’t see,” she remembered.
Her vision returned after a few minutes, but several months and a half-dozen medical specialists later, the 20-year-old goalie was diagnosed with a mysterious condition known as POTS.
First described more than 150 years ago, the syndrome has proliferated since the coronavirus pandemic. Researchers estimate that before 2020, 1 million to 3 million people suffered from POTS in the United States.
Precise numbers are difficult to come by because the condition encompasses a spectrum of symptoms, and many people have never heard of it. Recent studies suggest that 2 to 14 percent of people infected with the coronavirus may develop POTS.
The syndrome tends to strike suddenly, leaving previously healthy people unable to function, with no clear cause. In recent years, doctors specializing in the condition have noticed a curious and disproportionate subset of patients: young, highly trained athletes who are female.
Short for postural orthostatic tachycardia syndrome, POTS is diagnosed when a patient’s heart rate goes berserk, jumping way above normal when changing position from lying down to standing.
Teens and young adults at peak fitness are generally regarded as being extremely healthy, so the burst of POTS cases has puzzled doctors.
Several factors may be conspiring, said Robert Wilson, a neurologist who runs the Cleveland Clinic’s POTS practice. It could be that women of childbearing age are more vulnerable to inflammation.
It could reflect the damage that comes with being hit with a virus unknown to humans until 2020. And the stress associated with repetitive physical exhaustion could leave athletes at risk. “It’s something of a perfect storm of susceptibility,” Wilson said.
Dongngan Truong, a pediatric cardiologist at the University of Utah Health, speculated that the surge in cases might reflect athletes’ often unusual physiology or simply be reporting bias. “It could just be athletes generally keeping in touch with their bodies more,” Truong said.
Concerns about the health of athletes made headlines early in the pandemic — but the focus wasn’t on POTS. It was another heart condition.
Prominent sports figures — including Boston Red Sox pitcher Eduardo Rodriguez — revealed that after enduring COVID-19, they experienced inflammation of the heart muscles known as myocarditis, a leading cause of sudden death in athletes.
The NCAA started a registry to track athletes. Professional sports teams and schools introduced heart screenings before allowing athletes to return to play.
Myocarditis was not as common as feared, and a study published later in the journal Heart showed that elite athletes who were affected had no long-lasting heart damage. However, the scrutiny led to a wave of important research.
At the University of Alabama at Birmingham, Sara Gould, an orthopedic surgeon, and Camden Hebson, a pediatric cardiologist, opened a sports clinic in 2021 to help young athletes navigate their health post-covid. It drew patients from across the South and beyond, but the physicians were surprised to find that few of the patients had myocarditis. Most were coming in with POTS.
