Long COVID and the Heart: What the Evidence Shows

By Dr Nabila Laskar — published September 2026.

Long COVID commonly causes cardiac symptoms including palpitations, breathlessness, and POTS. Dr Nabila Laskar explains what the evidence shows and when to seek cardiac assessment.

Since 2020, I have seen a significant number of patients in clinic whose cardiac symptoms began or worsened following COVID-19 infection. The relationship between COVID-19 and the heart is now much better understood than it was in the early pandemic years, and proper cardiac assessment for people with persistent symptoms is both appropriate and important.

The most common cardiac presentations after COVID-19

The most frequently reported post-COVID cardiac symptoms are palpitations, exercise intolerance, breathlessness out of proportion to exertion, chest tightness or discomfort, and a rapid heart rate on standing. This constellation of symptoms, particularly when associated with fatigue and brain fog, is increasingly recognised as consistent with POTS (postural tachycardia syndrome) triggered by COVID-19.

POTS and long COVID

Post-COVID POTS is now one of the most common reasons I see younger patients in clinic. The mechanism is thought to involve autonomic nervous system dysregulation following the infection, causing the heart rate to rise excessively on standing as the normal blood vessel response to position change fails. Diagnosis requires demonstrating the characteristic heart rate rise on moving from lying to standing, confirmed by active stand testing. Many patients have previously been told their symptoms are anxiety-related, which delays appropriate assessment and management.

Myocarditis and pericarditis

Inflammation of the heart muscle (myocarditis) or its surrounding sac (pericarditis) can occur following COVID-19 infection, though the incidence appears lower than initial reports suggested. These conditions typically cause chest pain, palpitations, and breathlessness in the weeks following infection. ECG and echocardiogram are the key initial investigations, with cardiac MRI adding important detail where myocarditis is suspected.

When symptoms do not reflect structural damage

Many patients with persistent cardiac symptoms following COVID-19 have entirely normal echocardiograms and ECGs. A normal cardiac assessment does not invalidate the symptoms, but it is an important and reassuring finding that guides management toward autonomic rehabilitation, graded exercise, and symptom-directed treatment rather than cardiac medication.

When to seek cardiac assessment after COVID-19

I would recommend formal cardiac review if you have experienced persistent palpitations, chest pain, breathlessness significantly out of proportion to your activity level, or rapid heartbeat on standing that has persisted for more than four weeks after a COVID-19 infection. A resting ECG and echocardiogram, combined with active stand testing where POTS is suspected, will provide a clear picture of whether a cardiac abnormality is driving your symptoms.

You do not need a GP referral to be seen at The Cardiology Doctors.

Medically reviewed by Dr Nabila Laskar, Consultant Cardiologist, GMC 7040901.