Many patients with POTS and dysautonomia are told their racing heart, dizziness, nausea, sweating, or body-wide alarm is anxiety. Some are referred to psychiatry after cardiac, gastrointestinal, or neurologic testing does not clearly explain the symptoms.
The symptoms are real. In many cases, the missing piece is the autonomic nervous system.
The autonomic nervous system controls automatic body functions, including heart rate, blood pressure, digestion, sweating, temperature regulation, and blood flow. When this system becomes unbalanced, patients may experience a wide range of symptoms that feel frightening, unpredictable, and difficult to explain.
What POTS Can Feel Like
Postural Orthostatic Tachycardia Syndrome, or POTS, is one form of dysautonomia. It is often associated with lightheadedness, dizziness, racing heart, fatigue, brain fog, nausea, shakiness, and symptoms that worsen with standing.
But POTS is not only about feeling dizzy when standing up. Some patients experience sudden heart rate spikes, adrenaline surges, sweating, tremors, and a physical sense of panic even when they are not mentally anxious.
This can feel like anxiety from the outside, but the driver may be physiologic.
Why It Happens in Hypermobile Patients
In patients with hypermobility or Ehlers-Danlos syndrome, connective tissue laxity may affect blood vessels as well as joints. When the blood vessels are overly stretchy, blood may pool in the lower body when standing instead of returning efficiently to the heart and brain.
Some patients may also have upper cervical instability or nerve irritation that contributes to sympathetic nervous system overactivity. When the body is stuck in fight-or-flight, symptoms can include tachycardia, poor sleep, temperature sensitivity, digestive shutdown, and a constant sense of internal alarm.
More Than Heart Rate
Dysautonomia can affect the gut, brain, skin, and muscles. Patients may experience reflux, nausea, constipation, gastroparesis-like symptoms, exercise intolerance, cognitive crashes, hot and cold flashes, abnormal sweating, or Raynaud’s-type color changes in the hands and feet.
These symptoms can look scattered when each system is evaluated separately. Together, they may point to autonomic dysfunction.
What a Proper Workup Requires
A proper workup should ask what is driving the autonomic instability. Is there hypermobility? Cervical instability? Mast cell activation? Chronic pain? Inflammation? Deconditioning? Medication sensitivity?
Treatment may include hydration and salt strategies, compression, carefully selected medications, nervous system regulation, and in some cases targeted procedures such as stellate ganglion blocks.
Our Approach at MPM
At Manhattan Pain Medicine, we evaluate POTS and dysautonomia as part of a broader pain and connective tissue pattern, helping patients understand whether symptoms are being driven by nervous system overactivity, hypermobility, inflammation, or a layered chronic pain process.
