Dysautonomia / POTS

Postural orthostatic tachycardia syndrome (POTS) and orthostatic hypotension (OH) are more than just a high heart rate or low blood pressure. With POTS there is an extreme increase in heart rate when standing, with OH a drop in blood pressure.

The complaints associated with Postural Orthostatic Tachycardia Syndrome (POTS) can sometimes occur after brain injury or concussion, but also with post-COVID syndrome. These complaints fall under the umbrella term dysautonomia. In these conditions, the so-called autonomic nerves, nerves that control organs such as the heart, lungs and blood vessels, do not work properly. 
This may be due to 'dysfunctional signal processing' in the brainstem and/or the vagus nerve.
A disturbance in the neurological signal in the nervous system, which ensures a balance in the dampening and activation of organs and
control systems.


The heart rate suddenly increases extremely (tachycardia) when standing. This usually happens within ten minutes after standing, causing the heart to have more than 120 beats per minute or at least a difference of 30 beats per minute compared to the lying position.
The person who suffers from this temporarily has too little blood with oxygen reaching the head when he or she gets up. The heart will try to compensate for this, causing an increase in heart rate of sometimes forty beats per minute compared to lying down. The brain can no longer regulate blood pressure and heart rate properly.
This phenomenon can be induced by a doctor and therefore determined with a 'tilt table', in which the bed on which the patient lies is raised to about 60/70%, bringing the patient almost into a standing position. Blood pressure and heart rate are monitored at all stages.


Autonomous functions

Blood pressure and heart rate are among the 'autonomous functions' functions that you have no influence on. They function autonomously. The brain stem is part of that autonomic system. The autonomic or vegetative nervous system regulates heart rate, blood pressure, breathing, digestion, tears and temperature: sweating, flushing and shivering.


Multiple forms of Dysautonomia

There are several forms of dysautonomia. The most common forms of dysautonomia are:

  • Neurocardiogenic Syncope / NCS, also called vasovagal syncope
  • Postural Orthostatic Tachycardia Syndrome / POTS
  • Orthostatic intolerance / OI
  • Orthostatic hypotension / OH


Dysautonomia symptoms can also occur in Parkinson's disease, Multiple Sclerosis (MS), Multiple System Atrophy (MSA), fibromyalgia, Myalgic Encephalomyelitis (ME), Ehlers Danlos syndrome EDS, Pure Autonomic Failure (PAF).


Symptoms of dysautonomia - POTS

  • dizziness
  • tendency to faint
  • palpitations
  • becoming unwell, for example having to wait in a queue or having difficulty sitting upright for a long time

These complaints usually occur or worsen when standing or getting up from a lying position. The complaints may be accompanied by a general feeling of malaise (weakness), gastrointestinal complaints, nausea, disturbance of sweat function and blurred vision.


More women than men

Abnormal activity of the autonomic nervous system may be the cause of this condition. If someone has a brain injury and complains of dizziness when standing up or getting up from a lying position with an extremely rapid increase in pulse rate, then investigation is required.
This condition is more common in women than in men and more common in young people than in the elderly.



Four out of five patients with POTS were diagnosed with a psychiatric or psychological condition before receiving a POTS diagnosis.
In addition, little attention may be paid to the fact that problems within the body can reinforce each other in conditions such as MCAS, ME/CFS, and POTS.



Once a doctor has diagnosed Dysautonomia / POTS, a solution can be sought, depending on the person, sometimes with more exercise, sometimes with medication or water or salt intake. It is important that Dysautonomia/POTS is treated. 


Hereditary dysautonomia

There is also a hereditary form of dysautonomia: familial dysautonomia (Riley-Day syndrome) causing the nerves of the autonomic nervous system to malfunction. With this hereditary variant, the sensory nerves that deal with heat, cold and pain also work less.


Relevant links