What is Postural Orthostatic Tachycardia Syndrome (POTS)
Do you feel dizzy or lightheaded when you stand up? Does your heart suddenly race, even if you haven’t moved much? You’re not alone — and these symptoms could be signs of a commonly misunderstood condition known as POTS, or Postural Orthostatic Tachycardia Syndrome.
At Johnson County Integrative Medicine, we work with individuals who struggle with persistent symptoms that don’t always have easy explanations. One of those conditions is POTS — a syndrome that can affect nearly every part of daily life, yet often goes undiagnosed for years.
First, What Does “Syndrome” Actually Mean?
Before diving into what POTS is, it’s important to understand what a syndrome is. The word “syndrome” refers to a collection of signs and symptoms that tend to occur together, but don’t always have a single clear cause.
This means that POTS isn’t one disease with a universal cause or treatment — it’s a cluster of symptoms that indicate something is not functioning properly in the autonomic nervous system, which controls automatic body processes like heart rate, blood pressure, and digestion.
Because it’s a syndrome, POTS can look very different from person to person. And while there is a medical definition based on heart rate changes with standing, the underlying causes and symptom severity can vary dramatically.
What Exactly Is POTS?
Postural Orthostatic Tachycardia Syndrome is a type of dysautonomia, or autonomic nervous system dysfunction. It is characterized by:
A rapid increase in heart rate (typically 30+ beats per minute in adults, or over 120 bpm total) within 10 minutes of standing
No significant drop in blood pressure, which distinguishes it from other conditions like orthostatic hypotension
But it’s not just about heart rate — POTS often comes with a wide range of symptoms that affect the whole body:
Lightheadedness or dizziness
Fatigue and exercise intolerance
Brain fog or trouble concentrating
Nausea, bloating, or GI discomfort
Cold or discolored hands and feet
Palpitations or chest discomfort
Fainting or near-fainting spells
Why Does POTS Happen?
A Closer Look at Potential Causes and Contributing Factors
Because POTS is a syndrome, there is no one-size-fits-all cause. In fact, most patients with POTS have multiple contributing factors. Below are some of the most well-recognized potential causes and triggers:
1. Viral or Post-Infectious Onset
Many people develop POTS after a viral infection. This has become especially common after COVID-19. Viruses like Epstein-Barr Virus (EBV), influenza, or even gastrointestinal infections may trigger inflammation or damage to the autonomic nervous system. This is sometimes referred to as post-viral dysautonomia.
2. Autoimmune Dysfunction
There is growing evidence that POTS may have an autoimmune component in some individuals. Autoantibodies that interfere with nervous system function have been found in subsets of POTS patients. People with POTS are also more likely to have other autoimmune conditions, such as:
Hashimoto’s thyroiditis
Lupus
Sjögren’s syndrome
Rheumatoid arthritis
Autoimmunity may attack receptors or nerves involved in regulating blood pressure, heart rate, and vascular tone.
3. Hypovolemia (Low Blood Volume)
Some patients with POTS have chronically low blood volume (hypovolemia). This can result in:
Reduced blood flow to the brain upon standing
Increased heart rate to compensate
Feelings of dizziness or faintness
This low volume may be related to poor fluid or salt retention, excess loss through sweating or urine, or even hormonal imbalances that affect fluid balance.
4. Neuropathic POTS
In some cases, POTS is due to damage or dysfunction of small nerve fibers in the legs and lower body. These nerves help control blood vessel constriction. If they don't work properly, blood pools in the lower extremities when standing, forcing the heart to beat faster to maintain circulation.
This form is often referred to as neuropathic POTS and may overlap with small fiber neuropathy.
5. Hyperadrenergic POTS
Some individuals have excessive activation of the sympathetic ("fight-or-flight") nervous system. These patients may have:
High levels of norepinephrine when standing
Shakiness, anxiety, and palpitations
Blood pressure that rises rather than stays normal
This “hyperadrenergic” subtype of POTS may be linked to genetic predisposition, mast cell activation, or chronic stress.
6. Mast Cell Activation Syndrome (MCAS)
MCAS is a condition where immune cells called mast cells release chemicals inappropriately, causing allergic-type reactions throughout the body. There is increasing overlap being observed between POTS and MCAS, especially in people with:
Flushing
Hives or itching
GI distress
Sensitivity to foods, smells, or medications
These reactions may lead to vascular instability, contributing to POTS symptoms.
7. Hormonal Imbalances
Hormones like cortisol, aldosterone, estrogen, and thyroid hormones all influence fluid balance, blood vessel tone, and nervous system regulation. Low levels of aldosterone or cortisol, for example, may reduce the body's ability to retain salt and maintain blood pressure, worsening POTS.
8. Genetic Conditions or Connective Tissue Disorders
Many POTS patients, especially young women, also have features of joint hypermobility or are diagnosed with Ehlers-Danlos Syndrome (EDS). Loose connective tissue may allow excessive pooling of blood in the legs when standing, triggering tachycardia and dizziness.
9. Mitochondrial Dysfunction and Cellular Energy Deficits
Emerging research suggests that energy production problems at the cellular level may play a role in some cases of POTS. People with mitochondrial dysfunction may struggle to meet the energy demands of upright posture, leading to fatigue, brain fog, and exercise intolerance.
10. Deconditioning (But Not the Whole Story)
POTS is sometimes dismissed as a result of deconditioning, especially in young women. While lack of exercise or prolonged bed rest can make symptoms worse, it is rarely the root cause. In fact, many people with POTS were active and healthy before a sudden illness or trigger.
POTS Is Real — And You’re Not Alone
POTS is often dismissed, misdiagnosed as anxiety, or brushed off as a “normal” reaction to stress. But if you’ve been experiencing symptoms like dizziness, fatigue, rapid heartbeat, and brain fog, it’s important to know that POTS is a real medical condition with real physiological changes.
At Johnson County Integrative Medicine, we take a comprehensive approach to diagnosing and understanding the root causes of POTS, going beyond surface-level symptoms to uncover the full picture. We are located in Overland Park, KS and serve patients from all over the Kansas City Metro area.