POTS is a form of autonomic dysfunction that can cause rapid heart rate, dizziness, fatigue, brain fog, GI symptoms, and chronic pain overlap.
This video explains how POTS may affect standing tolerance, heart rate, fatigue, abdominal symptoms, hypermobility, and chronic pain.
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Hi, I’m Dr. Nino Mikaberidze. I’m a rheumatologist at Manhattan Pain Medicine. I’d like to talk about postural orthostatic tachycardia syndrome, or POTS, because it’s a condition that can feel very confusing if you don’t know what’s happening in your body.
POTS is a condition when your heart rate increases abnormally when you move from sitting or lying down to standing. That change can lead to symptoms like dizziness, lightheadedness, fatigue, palpitations, or even feeling like you might faint. At its core, POTS is related to the autonomic nervous system, which controls things your body should do automatically, such as regulating heart rate and blood pressure. When that system is not functioning properly, your body can struggle to adjust when you are upright.
Patients often describe feeling okay when they are lying down, but much worse when they are standing or moving around. Some also experience brain fog, weakness, or difficulty getting through daily activities. The exact cause is not always clear, but POTS can be associated with things like hypermobility conditions, autoimmune disorders, or changes in blood volume and circulation. That’s why it is important to look at the full picture, not just one symptom.
Diagnosis usually involves a detailed history, a physical exam, and sometimes specialized testing to see how your heart rate and blood pressure respond to changes in position. The good news is that there are many ways to manage POTS. Treatment often starts with lifestyle adjustments like increasing fluid and electrolytes, using compression, and gradually building tolerance to activity. In some cases, we also use medications to help regulate heart rate and blood pressure.
Because POTS can overlap with other conditions, we often take a team-based, coordinated approach to make sure all contributing factors are addressed. If you have been experiencing symptoms like dizziness with standing, unexplained fatigue, or a racing heart, it is worth getting evaluated. With the right diagnosis and plan, many patients are able to feel more stable, more functional, and more in control of their symptoms.
Postural Tachycardia Syndrome, or POTS, is a form of dysautonomia involving the autonomic nervous system. It is associated with symptoms that worsen when standing, along with an exaggerated heart rate increase after moving upright.
Common symptoms may include rapid heart rate, dizziness, lightheadedness, fatigue, brain fog, palpitations, weakness, nausea, abdominal symptoms, exercise intolerance, and near-fainting.
POTS is commonly evaluated with orthostatic vital signs, a 10-minute standing test, or head-up tilt table testing. Because symptoms can overlap with cardiovascular, neurologic, endocrine, post-viral, autoimmune, hypermobility, and chronic pain conditions, careful evaluation is important.
At Manhattan Pain Medicine, evaluation begins by understanding the full autonomic and pain pattern. For patients looking for POTS treatment in Manhattan, MPM does not replace cardiology, neurology, autonomic testing, primary care, or emergency care when those are needed.
Instead, MPM helps evaluate pain contributors that may overlap with POTS, including hypermobility, EDS, MCAS-like symptoms, peripheral neuropathy, abdominal pain, pelvic floor dysfunction, post-COVID pain, autoimmune-related pain, fibromyalgia, and chronic pain sensitization.
Care may include medication management, acupuncture, functional support, and selected interventional options when clinically appropriate.
POTS can be difficult to recognize because symptoms often affect multiple systems at once. A patient may feel dizzy when standing, notice a racing heart, develop fatigue or brain fog, and also experience nausea, abdominal pain, constipation, headaches, sleep disruption, pelvic symptoms, or widespread pain. Some patients are told symptoms are anxiety, deconditioning, or unexplained before autonomic dysfunction is considered.
POTS can overlap with hypermobility, EDS, MCAS-like symptoms, post-COVID symptoms, autoimmune disease, peripheral neuropathy, pelvic floor dysfunction, fibromyalgia, and chronic pain. These overlaps should be evaluated carefully rather than assumed.
MPM’s diagnosis-first approach helps determine whether pain and symptom burden appear autonomic, neurologic, musculoskeletal, hypermobility-related, inflammatory, post-viral, pelvic, or part of a broader chronic pain pattern.
POTS fits within MPM’s Autonomic Dysfunction and Hypermobility Zones of Expertise. This matters because many patients do not present with dizziness alone. They may also have EDS, hypermobility spectrum disorder, peripheral neuropathy, abdominal pain, nausea, constipation, pelvic floor dysfunction, MCAS-like symptoms, autoimmune overlap, post-COVID pain, or fibromyalgia.
MPM uses the Zones of Expertise framework to evaluate whether symptoms appear primarily autonomic, hypermobility-related, neuropathic, musculoskeletal, pelvic, inflammatory, post-viral, or centralized. For some patients, the priority is formal autonomic or cardiovascular evaluation. For others, POTS is already diagnosed, but chronic pain, GI symptoms, or functional limitation remain major barriers to daily life.
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I genuinely can’t say enough good things about the team at Manhattan Pain Medicine. I have MCAS, EDS, and an inflammatory autoimmune disease, and I’ve basically been searching for answers since I was a kid. I had years of unexplained inflammation markers, chronic pain, and allergic reactions despite...
I have a complex medical history and have seen a lot of doctors over the years. Dr. Mikaberidze and Dr. Siefferman each took the time to really listen and understand everything I had been dealing with. I also appreciated how they work together and communicated about my care. I left with a plan that...
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I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
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POTS stands for Postural Tachycardia Syndrome, also called Postural Orthostatic Tachycardia Syndrome. It is a form of dysautonomia involving the autonomic nervous system. In POTS, symptoms occur or worsen when a person stands, along with an exaggerated increase in heart rate. Symptoms may include rapid heartbeat, dizziness, lightheadedness, fatigue, brain fog, palpitations, weakness, nausea, abdominal symptoms, exercise intolerance, and near-fainting. POTS is not simply anxiety, although anxiety and stress can affect symptom burden. A qualified clinician should evaluate the full pattern and rule out other causes.
Common POTS symptoms include fast heart rate when standing, dizziness, lightheadedness, fatigue, brain fog, palpitations, weakness, shakiness, headaches, exercise intolerance, nausea, abdominal pain, bloating, constipation, and near-fainting. Some patients also experience chronic pain, temperature sensitivity, sleep disruption, pelvic symptoms, or symptoms that worsen after meals, heat exposure, prolonged standing, dehydration, or illness. Symptoms can vary from day to day and may overlap with other medical conditions. Because dizziness, tachycardia, fatigue, and brain fog can have many causes, evaluation should not rely on symptoms alone.
POTS is commonly evaluated with orthostatic vital signs, a 10-minute standing test, or a head-up tilt table test. Diagnostic criteria generally include orthostatic symptoms and a sustained heart rate increase after standing, without orthostatic hypotension. In adults, a heart rate increase of at least 30 beats per minute is often used, while adolescents may use a higher threshold. Additional testing may be needed to rule out other causes such as dehydration, anemia, thyroid disease, medication effects, arrhythmia, endocrine disorders, neurologic disease, or post-viral complications.
POTS can have different contributors depending on the patient. It may involve autonomic dysfunction, altered blood vessel regulation, deconditioning, low blood volume, neuropathy, post-viral changes, medication effects, autoimmune overlap, hypermobility, or related conditions. Some patients develop POTS-like symptoms after infection, surgery, pregnancy, concussion, or COVID-19. In other cases, the cause is not clear. The important point is that POTS symptoms should be evaluated in context, including heart rate, blood pressure, hydration, medications, medical history, pain patterns, and overlapping diagnoses.
Yes. Some people recovering from COVID-19 may develop POTS-like symptoms or autonomic dysfunction, including dizziness, rapid heart rate when standing, fatigue, brain fog, exercise intolerance, and GI symptoms. However, post-COVID symptoms can overlap with other conditions, including cardiac, neurologic, pulmonary, endocrine, hematologic, and medication-related problems. Careful evaluation is important before symptoms are attributed to POTS. MPM evaluates post-COVID pain and autonomic symptom overlap while coordinating with cardiology, neurology, primary care, pulmonology, or other specialists when needed.
POTS is commonly discussed alongside Ehlers-Danlos syndrome, hypermobility spectrum disorder, and MCAS-like symptoms, and many patients report overlapping patterns. These may include dizziness, fatigue, joint instability, widespread pain, GI symptoms, flushing, headaches, pelvic floor dysfunction, or nerve sensitivity. However, overlap does not prove that one condition caused the others. Each condition needs individual evaluation. MPM considers autonomic symptoms, hypermobility, pain pattern, neuropathy, MCAS-like symptoms, and autoimmune clues together so care is not oversimplified.
POTS treatment is individualized and often includes hydration, salt strategies when medically appropriate, compression garments, graded exercise or physical therapy, medication management, sleep support, and treatment of overlapping conditions. These strategies should be medically guided, especially for patients with high blood pressure, kidney disease, heart disease, pregnancy, eating disorders, or complex medical histories. Some patients may need medications that affect heart rate, blood volume, or blood vessel tone. MPM’s role is to support pain, function, and overlapping symptom burden while coordinating POTS management with appropriate clinicians.
A pain specialist may be helpful when POTS overlaps with chronic pain, peripheral neuropathy, abdominal pain, pelvic pain, hypermobility-related pain, EDS, fibromyalgia, post-COVID pain, or chronic symptom sensitization. MPM does not replace cardiology, neurology, autonomic testing, or primary care for POTS diagnosis and systemic management. Instead, MPM helps evaluate pain drivers, functional limitation, nerve-related symptoms, pelvic floor dysfunction, and chronic pain pathways that may complicate POTS. The goal is coordinated care that addresses both autonomic symptoms and the pain patterns affecting daily life.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Postural Tachycardia Syndrome, or POTS, is a form of dysautonomia involving the autonomic nervous system. The autonomic nervous system helps regulate body functions that happen automatically, including heart rate, blood pressure, digestion, sweating, temperature regulation, and blood vessel tone. In POTS, symptoms occur or worsen when a person moves upright, often with an exaggerated increase in heart rate.
For many patients, POTS is more than a racing heart. It can affect standing tolerance, fatigue, thinking, digestion, exercise capacity, pain, and daily activity. Patients may feel dismissed when symptoms are described as anxiety or stress alone. While stress can amplify symptoms, POTS symptoms deserve careful medical evaluation.
POTS symptoms often appear when standing, walking, showering, exercising, being in heat, eating, or staying upright for too long. Patients may notice a rapid heartbeat, palpitations, dizziness, lightheadedness, near-fainting, weakness, shakiness, fatigue, brain fog, headaches, chest discomfort, nausea, abdominal pain, constipation, bloating, or exercise intolerance.
Some patients feel better when lying down. Others have symptoms that fluctuate throughout the day or worsen during illness, dehydration, menstruation, post-viral recovery, poor sleep, or stress. The symptom pattern can be confusing because it may involve the heart, nervous system, GI tract, muscles, joints, and pain pathways at the same time.
POTS diagnosis usually involves symptoms of orthostatic intolerance and objective heart rate changes when standing. Testing may include orthostatic vital signs, a 10-minute standing test, or head-up tilt table testing. Additional testing may be needed to rule out other causes of tachycardia, dizziness, fatigue, or fainting, such as dehydration, anemia, thyroid disease, arrhythmia, medication effects, endocrine disorders, neurologic conditions, or blood pressure abnormalities.
Some patients also undergo autonomic testing, echocardiogram, bloodwork, urine testing, nerve testing, or other studies depending on symptoms. MPM reviews prior autonomic, cardiology, neurology, and primary care evaluations, but POTS diagnosis and systemic management may require clinicians who specialize in autonomic or cardiovascular care.
POTS can involve symptoms outside the cardiovascular system. Nausea and abdominal pain are common noncardiovascular complaints, and patients may also report bloating, constipation, early fullness, or vomiting.
These symptoms can overlap with gastroparesis, chronic constipation, MCAS-like symptoms, abdominal pain, stomach pain, pelvic floor dysfunction, and autonomic dysfunction. A patient with POTS and abdominal pain may need GI evaluation, nutrition guidance, pelvic floor evaluation, pain medicine input, or autonomic management depending on the pattern. MPM helps evaluate where pain fits into this broader picture.
Many patients with POTS also report hypermobility, EDS, joint pain, widespread pain, headaches, GI symptoms, flushing, allergic-type symptoms, or MCAS-like patterns. These overlaps are commonly discussed, but they should be handled carefully. Having symptoms in more than one category does not automatically prove a single cause.
MPM evaluates whether symptoms may be related to hypermobility-related joint strain, peripheral neuropathy, pelvic floor dysfunction, autoimmune-related pain, MCAS-like symptoms, post-COVID pain, fibromyalgia, or chronic pain sensitization. This helps avoid both overdiagnosis and dismissal.
Some people develop POTS-like symptoms after COVID-19 or another viral illness. Symptoms may include dizziness, tachycardia when standing, fatigue, brain fog, exercise intolerance, headaches, GI symptoms, and pain. Careful evaluation is important because symptoms can overlap with other post-COVID complications.
MPM evaluates post-COVID pain and autonomic symptom overlap through a coordinated lens. Some patients need cardiology, neurology, pulmonology, primary care, rehabilitation, or GI care. Others also need help understanding pain, pacing, neuropathy, pelvic symptoms, or chronic pain sensitization.
POTS treatment is individualized. Many care plans include hydration, salt strategies when appropriate, compression, graded exercise or physical therapy, medication management, and treatment of overlapping conditions. There is no single cure, but treatments and lifestyle changes may help manage symptoms for selected patients.
These strategies should be medically guided. Salt loading, compression, exercise programs, and medication changes may not be appropriate for every patient, especially when high blood pressure, kidney disease, heart disease, pregnancy, eating disorders, or complex medical histories are present.
MPM’s role is to support the pain and function side of care. This may include medication management, acupuncture, coordination with physical therapy, and evaluation of neuropathic, musculoskeletal, pelvic, abdominal, or centralized pain contributors. Stellate ganglion blocks, lidocaine and ketamine infusions, and other interventional options are not standard first-line POTS treatments and should not be described as treating the underlying cause of POTS. They may be discussed only in selected clinical contexts when the pain or autonomic-related pattern supports consideration.
Patients should seek urgent care for chest pain, severe shortness of breath, fainting with injury, new neurologic symptoms, severe weakness, irregular heartbeat, severe dehydration, or rapidly worsening symptoms. These symptoms may have causes other than POTS and should not be managed as routine dysautonomia without evaluation.
MPM approaches POTS-related pain through a diagnosis-first, coordinated model. The evaluation considers autonomic symptoms, hypermobility, EDS, peripheral neuropathy, abdominal pain, pelvic floor dysfunction, autoimmune-related pain, post-COVID symptoms, MCAS-like symptoms, fibromyalgia, and chronic pain sensitization.
For patients looking for POTS treatment in Manhattan, MPM offers a careful, patient-centered approach to the pain and functional symptoms that may overlap with autonomic dysfunction. The goal is to support clearer evaluation, safer coordination, improved function, and a care plan that reflects the patient’s symptoms, prior testing, medical risks, and long-term goals.
