POTS Causes and Considerations
Updated: Mar 19
Postural Orthostatic Tachycardia Syndrome, or POTS, is one of many different forms of dysautonomia. Dysautonomia is a general term that is used to describe any dysfunction of the autonomic nervous system. There are numerous different conditions and diseases that can lead to impaired functioning and integrity of the autonomic nervous system, so it is often difficult to properly diagnose the root cause behind dysautonomia symptoms. Traditionally, POTS and other forms of dysautonomia are thought to be a secondary manifestation from another disease, such as amyloidosis, Celiac disease, Chiari malformation, chronic inflammatory demyelinating polyneuropathy, Crohn’s disease, Ulcerative Colitis, Ehlers-Danlos Syndrome, and other autoimmune diseases(1).
However, POTS in particular can occur from other less threatening etiologies as well. In our clinic, a great majority of people experiencing POTS symptoms have no known autoimmune or underlying diseases, even after extensive cardiac, metabolic, and psychological testing. Many of these people develop POTS after sustaining a concussion, after a sickness (usually a viral infection), after a traumatic episode (mental, emotional, or physical), or sometimes after certain vaccinations. Along with orthostatic intolerance (subjective symptoms upon changing positions from lying to standing along with an abnormal increase in their heart rate), these people will also commonly have symptoms related to floating (sensation of their head or body not connected to the ground), disorientation, “tilting” of their head or body (in which they don’t feel that their body is straight and angled off to one side), brain fog, and/or constant symptoms (in which symptoms like headache, fatigue, or dizziness are always present throughout the entire day). In these cases, it is imperative to consider a neurological causation and impairment that be the root of the POTS symptoms.
POTS is widely considered an impairment of gravity regulation (orthostatic intolerance), but neurological health and functioning is traditionally not evaluated when considering treatment for POTS. There are receptors in your inner ear, called the otolithic organs, that are primarily involved in gravity regulation and integration. As such, if there is dysfunction in the signaling of these neurological pathways from the inner ear to the brainstem, POTS can develop. Many times, the subjective symptoms experienced in addition to postural intolerance (mentioned above) are clues that suggest vestibular imbalance. We find that people who experience symptoms of dizziness in addition to the lightheadedness that occurs when standing is a good indicator of vestibular imbalance or impairment. Very commonly, people will also have some symptoms that are constant in nature; such as a low-grade chronic headache, head pressure, brain fog, or even blurry vision. Many clinicians and patients alike have been baffled by this; how can a symptom be constant and never relent? As gravity is the only constant in the world (other factors such as stress, overstimulation, and fatigue are transient), the underlying issue is commonly a dysregulation of gravity signals or an impairment in the integration of gravity itself (from a neurological sense). Imagine trying to stand up, walk around, or turn with one of your inner ear systems telling your brain one thing, while the other system gives you an entirely different feedback signal. This type of confusion or mismatch in feedback signaling usually results in the symptoms people experience with POTS. At our clinic, we find the inner ear system, or vestibular system, is commonly impaired in POTS, and when treated appropriately, POTS symptoms can be attenuated.
If you or someone you know is experiencing POTS symptoms along with other symptoms that suggest neurological or vestibular involvement, we recommend vestibular testing and a neurological evaluation to assess if neurological rehabilitation for treatment is warranted. We have seen many successful outcomes and recovery from POTS symptoms employing this method of treatment therapy. If you or someone you know suffers from POTS symptoms or similar symptoms of dysautonomia, please feel free to contact us at our website or book a free consultation with one of our doctors so we can speak with you directly about our recommendations.
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