Long COVID Heart Rate: Spikes, POTS, and Pacing

Long COVID can affect heart rate in several ways. You may see a faster resting rate or a large rise after standing. You may also notice sudden pounding beats. Apple Watch can save these patterns beside your symptoms. POTS, an abnormal rhythm, dehydration, or medicine could cause the change. Other conditions can cause it too.

Use the watch as a record. A repeated change matters more than one odd reading. Get urgent help if palpitations happen with chest pain. Severe breathlessness, fainting, or near fainting also need urgent help.

Last updated: September 1, 2026.

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What a changed heart rate can mean in Long COVID

A changed heart rate is a recognized Long COVID symptom. It can have several causes. The CDC lists palpitations and dizziness on standing as common symptoms. It also says Long COVID can affect several body systems.

One possible cause is dysautonomia. This affects the body's automatic control system. That system helps manage heart rate, blood pressure, temperature, and digestion. POTS is one form of dysautonomia. Its full name is postural orthostatic tachycardia syndrome. It can cause a lasting heart-rate rise after you stand.

A fast heart rate can have other causes. These include dehydration, anemia, fever, or thyroid problems. Medicine, pain, or an abnormal rhythm can also raise it. Heart and lung disease are other possible causes. A new pattern therefore needs a clinical review.

Four Apple Watch patterns worth saving

The best record pairs the number with the moment. Save what you were doing and how you felt. Note how long the change lasted. This context helps a clinician assess a standing response. It can also reveal a sensor error or a different heart problem.

Pattern	What it may show	What a clinician checks
Resting heart rate stays above your usual range	Your body is under more load than usual	The cause of that load
High after standing	Possible orthostatic intolerance, such as POTS	Whether it meets POTS rules
Sudden high or irregular reading	An episode to save and check again	Whether it is an abnormal rhythm or sensor error
HRV moves from your usual range	A change in beat timing that adds context	Whether you have Long COVID or dysautonomia

Resting heart rate above your baseline

Apple Watch estimates resting heart rate while you are inactive. It uses readings taken in the background. One high day can follow poor sleep, heat, alcohol, or infection. Stress, dehydration, and medicine can also raise it. A change across several days matters more than one high point.

Compare the trend with your own earlier data. Bring the weekly or monthly graph to a medical visit. Do this when the shift is new, lasting, or linked with worse symptoms.

Heart rate that jumps when you stand

Note any heart-rate rise after you stand. Record the time, starting position, symptoms, and length of the rise. Dizziness or blurred vision gives the number clinical context. So do weakness, nausea, shaking, and palpitations.

Apple Watch takes background readings at intervals. It can miss a brief rise or capture only part of it. A manual Heart Rate reading may help record the moment. A POTS assessment also needs your blood-pressure response.

A sudden high, low, or irregular reading

One value can be real or caused by movement. Poor contact, cold skin, or another sensor problem can also affect it. Apple says unusual high or low readings can appear. This can happen even when the watch works as designed.

Pause and take another reading while you are still. Check the band and clean the skin under the sensor. Contact a clinician if the value repeats or feels very unusual. Do the same if it comes with symptoms.

Heart rate variability that moves

Heart rate variability, or HRV, measures small differences in time between normal heartbeats. Apple Health stores HRV as SDNN, which is one specific way to calculate that variation. Apple Watch records separate HRV samples rather than one continuous daily measurement.

HRV changes with sleep, breathing, alcohol, illness, medicine, and fitness. The time of the reading also matters. Research has found group-level autonomic changes in some people with Long COVID.

A standing heart-rate rise can resemble POTS

POTS needs more than a fast pulse. The heart-rate rise lasts after a person stands. Symptoms of orthostatic intolerance must also be present. The blood-pressure drop that defines orthostatic hypotension is absent. Clinicians must also rule out other causes of tachycardia.

The Heart Rhythm Society consensus statement uses these heart-rate criteria:

For adults, an increase of at least 30 beats per minute after moving from lying down to standing.
For people aged 12 to 19, an increase of at least 40 beats per minute.
The rise occurs within 10 minutes and is accompanied by symptoms when upright.
There is no orthostatic hypotension that better explains the response.

These numbers are clinical criteria. NICE advises clinicians to record blood pressure and heart rate. They record both while the person is lying and standing. The check lasts 10 minutes when postural tachycardia is suspected.

Do not do a long standing test alone if you faint. The same applies if you nearly faint or cannot stand safely. Ask a clinician how to test in a safe setting. They may review an ECG, blood tests, medicine, and hydration. They will also consider other causes before making a diagnosis.

How Apple Watch records this data

Apple Watch can show useful heart-rate trends. It measures more often during a workout and uses background readings at other times. Sampling can change with movement and activity.

Apple explains how the watch calculates a daily resting rate. It combines background heart-rate readings with motion data. Apple Health also stores single heart-rate readings and automatic HRV samples. Apple Health uses SDNN for HRV. Apple's HealthKit documentation defines that method.

The watch can show when a pattern changed and what happened nearby.

Where to see the pattern in Body Insights

Use the same Body Insights views each time so that you compare like with like.

Open Body Insights.
On the Body tab, open Autonomic Health. Review HRV and resting heart rate against your recent pattern.
Open Sleep for the previous night's score, duration, interruptions, sleeping heart rate, and night HRV.
Read Pacing and Coach Advice before you plan the day.
Record the time and symptoms from any important episode in a short log.

On Apple Watch, open the Heart Rate app when you need a current reading. Stay still while the watch measures. A current reading can add context, but symptoms still matter more than a single number.

Make the record useful at a medical appointment

A short, consistent log is more useful than a folder of unexplained screenshots. Record the same details for each important episode so that a clinician can see the sequence.

Write down:

Date and exact time.
Body position: lying, sitting, standing, walking, or in a shower.
Heart rate before the change, at the peak, and after you rested.
Symptoms, including dizziness, chest discomfort, breathlessness, shaking, nausea, weakness, or near fainting.
How long the episode lasted.
Any recent infection, fever, poor sleep, heat, or change in fluids.
Any change in food, caffeine, alcohol, or medicine.
What happened during the next 24 to 72 hours.
Any post-exertional symptom worsening during that period.

Follow your clinician's method when you record blood pressure. Blood-pressure readings are needed to assess orthostatic hypotension.

Ask the clinician what they want to rule out. The list may include POTS or another form of dysautonomia. It may include anemia, thyroid disease, or dehydration. Medicine effects and abnormal rhythms are also possible. A watch log can support that work.

Can Long COVID heart rate help with pacing?

Heart rate can add one signal to pacing. It should not become a universal stop line. Neither CDC nor WHO gives one safe ceiling for everyone with Long COVID. Medicine, age, fitness, POTS, and other conditions can change the response.

Pacing means matching activity to your current capacity. That includes physical, mental, emotional, and social activity. It aims to reduce post-exertional malaise. This is also called post-exertional symptom exacerbation. The CDC notes that symptoms can worsen after minor effort. The change often starts 12 to 48 hours later. The WHO recommends pacing and energy conservation when this delay occurs.

A practical review can use four questions:

Is resting heart rate or HRV outside my recent pattern?
Are standing symptoms, sleep, pain, infection symptoms, or fatigue also worse?
Can I reduce, split, delay, or replace an optional activity today?
What happened to my symptoms during the next one to three days?

The last question matters. A heart-rate rise does not prove a crash will follow. A normal-looking morning does not prove an activity is safe. Your repeated activity and symptom pattern is the useful evidence.

Discuss any personal heart-rate limit with a clinician. They should understand your symptoms and medicine. Do not use a generic age formula as a medical safety rule.

What about a low heart rate or low HRV?

Long COVID heart-rate searches often focus on a fast pulse. Some people also notice low readings. A low value can be normal during sleep or in a trained person. Medicine, a sensor error, or another medical cause can also lower it.

Check a surprising low reading again while you are still. Seek medical advice if it is new or repeats. Get advice if it comes with weakness, dizziness, or confusion. Breathlessness, chest discomfort, and fainting also need medical advice.

Low HRV also needs context. It means beat timing varied less during that sample. Compare readings from similar times and conditions. Then follow the trend instead of judging one sample.

Know when to seek urgent care

Apple Watch data can help you describe a pattern, but urgent symptoms need urgent care. Do not wait for another reading when your symptoms suggest a serious heart or breathing problem.

Call your local emergency number if palpitations or a fast heart rate happen with:

Chest pain or pressure.
Severe or new shortness of breath.
Fainting or feeling close to fainting.
Severe dizziness, new weakness, or a sudden change in alertness.

The American Heart Association advises emergency help for chest pain or pressure. It lists other possible signs of an abnormal rhythm. These include breathlessness, fainting, dizziness, and a fast heartbeat.

Arrange a routine appointment for a new pattern that keeps returning. Do the same if it limits normal activity. A clear change from your baseline also needs a review. Bring your log, screenshots, medicine list, and watch model.

Turn the trend into a daily check

The useful outcome is a short review of your own recent pattern before you decide what the day can hold.

Body Insights reads Apple Health data recorded by Apple Watch. This includes heart rate, resting heart rate, HRV, sleep, and activity. The app compares those signals with your recent baseline. It then gives you plain daily context.

The CDC, WHO, and NICE describe Long COVID symptoms and care. The Heart Rhythm Society consensus explains how clinicians assess POTS. Research on Long COVID wearables is still developing. It includes work on autonomic function and standing responses. Wearable measures can show trends and context.