By Dr. Robert Groysman, MD. Diplomate, American Board of Anesthesiology and American Board of Pain Medicine. COVID Institute, Plano, TX. Reviewed June 11, 2026.
You stand up and your heart pounds like you sprinted up stairs. The room tilts. You are exhausted in a way that sleep never touches, and every test your doctor ran came back normal. You were told it might be anxiety. It is not anxiety. What you are describing is one of the most common drivers of Long COVID, and it has a name.
What is dysautonomia in Long COVID?
Dysautonomia is dysfunction of the autonomic nervous system, the automatic control center that runs your heart rate, blood pressure, digestion and body temperature without you ever thinking about it. After a COVID infection this system can get stuck in overdrive. The result is a racing heart when you stand, dizziness, temperature swings and fatigue rest does not fix. The hardware of your body is intact. The control signals coordinating it have been disrupted.
Think of your autonomic nervous system as having a gas pedal and a brake. The sympathetic branch is the gas pedal, the fight-or-flight response. The parasympathetic branch is the brake, the rest-and-digest response. In Long COVID dysautonomia, the gas pedal sticks and the brake weakens. Your body stays revved even when you are lying still.
Why does Long COVID cause dysautonomia?
Long COVID disrupts the nervous system regulating the body, often through the vagus nerve and the autonomic pathways running through the brainstem. The virus and the immune response it triggers can leave these signaling pathways dysregulated long after the infection clears. This is functional dysregulation, not structural damage, which is exactly why standard imaging and bloodwork look normal while you feel anything but.
This matters because it changes what treatment should target. You are not looking for damaged tissue to repair. You are looking to reset a control system knocked out of balance.
How common is dysautonomia in Long COVID?
Dysautonomia is one of the most common features of Long COVID, not a rare complication. In a global survey of 2,314 adults with Long COVID, 66% scored in the moderate-to-severe range for autonomic dysfunction on the COMPASS-31, a validated clinical questionnaire (Larsen et al., Frontiers in Neurology, 2022). POTS, or postural orthostatic tachycardia syndrome, is one of the most recognized forms and a frequent new diagnosis after COVID.
If you have been made to feel that your symptoms are unusual or imagined, the data says the opposite. Autonomic involvement is the rule in Long COVID, not the exception.
Is POTS the same as dysautonomia?
POTS, or postural orthostatic tachycardia syndrome, is the most common specific form of dysautonomia seen after COVID. Dysautonomia is the umbrella term for a dysregulated autonomic nervous system. POTS is one pattern within it, defined by a heart rate jumping abnormally when you stand. If your heart races and you feel faint or dizzy when you stand up after COVID, POTS is the form of dysautonomia most likely involved.
You do not need a POTS label to have treatable dysautonomia. Many patients have clear autonomic dysfunction never meeting the strict POTS heart-rate threshold, and they respond to the same mechanism-based approach.
What does dysautonomia feel like?
Dysautonomia produces symptoms across multiple body systems at once, which is part of why it is so often missed. The most common include:
- A heart racing or pounding when you stand, shower or eat
- Lightheadedness, dizziness or near-fainting on standing
- Fatigue worsening after activity, unrelieved by rest
- Brain fog, trouble concentrating and word-finding problems
- Temperature dysregulation, night sweats or cold intolerance
- Digestive changes, nausea, bloating or early fullness
- Sleep broken or unrefreshing
No two patients have the same combination. The pattern of which symptoms hit hardest is itself a clue to what is driving them.
Why do my test results come back normal?
Standard tests look for structural damage, and dysautonomia is a problem of function, not structure. An echocardiogram can show a healthy heart while that same heart races uncontrollably on standing, because the issue is the signal telling it what to do, not the muscle itself. This gap between how you feel and what routine tests show is the single most common reason Long COVID patients are dismissed.
A proper evaluation does not stop at standard labs. It looks for the patterns of autonomic dysregulation directly, and it asks which of the underlying mechanisms is producing them. You can see how that works in our four-step diagnostic process and our approach to diagnosis.
How is dysautonomia in Long COVID treated?
Treatment for Long COVID dysautonomia aims to calm the overactive sympathetic system and restore the body’s natural balance, rather than only masking individual symptoms. The foundation is the standard autonomic toolkit of increased fluids and salt to expand blood volume, compression, a carefully graded exercise program respecting post-exertional malaise and rate-control medications.
One option targeting the dysregulation itself is the stellate ganglion block, or SGB, a precise injection of local anesthetic near a nerve cluster in the neck, performed under ultrasound guidance, aimed at resetting the balance between the sympathetic gas pedal and the parasympathetic brake.
The evidence is promising but still early, and you deserve the honest version. A retrospective cohort of 41 patients found that SGB relieved at least one Long COVID symptom in 86% of those treated (Pearson et al., Cureus, 2023). A more cautious 2025 cohort of 52 patients found that 56% improved but only about 14% had lasting relief, with most needing more than one injection (Chiang et al.). A 2026 systematic review of seven studies found improvement across all of them and concluded that the patients most likely to benefit are those with prominent autonomic dysfunction (Peddireddy et al., Current Pain and Headache Reports). None of these studies had a control group, so the effect is suggestive, not proven. For the right patient, whose Long COVID runs through the autonomic nervous system, SGB and related approaches such as epipharyngeal abrasive therapy and vagus nerve protocols may help where standard treatment has not.
If you want to go deeper, read about SGB for POTS specifically, or the Levine protocol for POTS.
Why a mechanism-based approach matters
The same symptom can come from more than one root cause, so the goal is to identify which mechanism is driving yours. Long COVID is driven by six interconnected biological mechanisms including dysautonomia, mitochondrial dysfunction, endothelial damage, gut dysbiosis, mast cell activation and hormone imbalance. They combine differently in every patient, like a fingerprint. Fatigue in one person traces to dysautonomia. In another it traces to mitochondrial dysfunction or to the microclots of endothelial damage.
This is why a one-size protocol falls short. Mapping your specific combination of mechanisms is what turns a list of symptoms into a treatment plan addressing causes instead of chasing effects.
Frequently asked questions
Is dysautonomia from Long COVID reversible?
Dysautonomia in Long COVID is a problem of function rather than permanent damage, which is why many patients improve when the underlying dysregulation is addressed. Recovery varies by person and depends on which mechanisms are involved and how long they have been active.
What is a stellate ganglion block?
A stellate ganglion block is an injection of local anesthetic near a cluster of nerves in the neck, guided by ultrasound. It aims to reset the balance between the sympathetic and parasympathetic nervous systems. It has a long history of use in pain medicine and is now being applied to post-viral autonomic symptoms.
Do I need a formal POTS diagnosis before being evaluated?
No. POTS is one form of dysautonomia, but you do not need an existing diagnosis to be evaluated. A comprehensive assessment looks for the full range of autonomic dysregulation, not a single label.
Where is the clinic located?
The COVID Institute is in Plano, Texas, serving the Dallas-Fort Worth area and patients who travel from across the country.
Take the next step
Your symptoms have real biological causes, and they can be mapped. A comprehensive evaluation begins with your story and identifies which of the six mechanisms are driving how you feel, so treatment targets the cause rather than the symptom.
Request a consultation with Dr. Groysman or start with our four-step diagnostic process.
Sources
- Larsen NW, et al. Characterization of autonomic symptom burden in long COVID: A global survey of 2,314 adults. Frontiers in Neurology. 2022. PubMed 36353127.
- Pearson L, Maina A, Compratt T, et al. Stellate Ganglion Block Relieves Long COVID-19 Symptoms in 86% of Patients: A Retrospective Cohort Study. Cureus. 2023. PMID 37711269.
- Liu LD, Duricka DL. Stellate ganglion block reduces symptoms of Long COVID: A case series. Journal of Neuroimmunology. 2022. PMID 34922127.
- Chiang MC, Satko KM, Shin C, et al. Stellate Ganglion Block for the Management of Long COVID Symptoms: A Retrospective Cohort Study. Cureus. 2025. PMC12374758.
- Peddireddy S, VanWingerden N, Patel P, Howard G, Berger J. Stellate Ganglion Block in the Treatment of Long COVID: A Systematic Review. Current Pain and Headache Reports. 2026;30(1):44. PMC13076556.