What Is POTS? Symptoms, Causes, and a Nervous System Approach
By Dr. Robert Pompella, DC · Invictus Chiropractic, Cypress, TX · Updated September 2026
Key points
POTS is a disorder of the autonomic nervous system that causes an abnormal jump in heart rate when you stand up.
It affects an estimated 1 to 3 million Americans, mostly women, and has been seen developing in previously healthy people after COVID-19.
Symptoms go well beyond a fast heartbeat and can seriously affect daily life.
We look at POTS as a sign that the nervous system, especially the vagus nerve, is out of balance.
If you or someone you love has POTS, you know how hard it can be. Dizziness, fatigue, a racing heart, and anxiety can flare up with a change in position or temperature, or during busy, stressful moments.
Many people are told that no one really knows what causes POTS, and that the main options are standing up slowly and eating more salt. Those steps help some people, but they often don’t get to what’s going on underneath.
What is POTS?
POTS (Postural Orthostatic Tachycardia Syndrome) is a disorder of the autonomic nervous system marked by an abnormal rise in heart rate when you stand. To be diagnosed, a person’s heart rate has to go up by at least 30 beats per minute, or above 120, within 10 minutes of standing, without a drop in blood pressure.
An estimated 1 to 3 million Americans have POTS, most of them women. Researchers have also seen POTS develop in previously healthy people after COVID-19.
What are the symptoms of POTS?
POTS is much more than a fast heartbeat. Common symptoms include:
Dizziness or lightheadedness when standing
Fatigue and weakness
Brain fog and trouble concentrating
Headaches
Heart palpitations
Shakiness or tremors
Shortness of breath
Chest pain
Nausea and digestive problems
Blurry or tunnel vision
Trouble sleeping
For some people, symptoms are mild and come and go. For others, they make basic things like showering, eating, or standing for a few minutes difficult. Research has found that quality of life with POTS can be similar to living with kidney disease on dialysis.
POTS can also take an emotional toll. Many people feel anxious, depressed, or hopeless, and struggle to keep up with school, work, relationships, and social plans.
Why is POTS so often missed?
POTS is still poorly understood and frequently misdiagnosed. Many people are told their symptoms are “all in their head,” or that they’re just out of shape or anxious. That can lead to long delays before they get answers and care.
What are the types of POTS?
There are a few subtypes of POTS:
Neuropathic POTS: The most common type. It’s tied to problems with the nerves that control heart rate and blood vessel tightening, including the vagus nerve.
Hyperadrenergic POTS: Linked to too much norepinephrine, a stress hormone. It often brings palpitations, anxiety, and higher blood pressure. Because the adrenal glands respond to the fight-or-flight system, this type often connects back to nervous system imbalance.
Hypovolemic POTS: Caused by low blood volume, from things like dehydration, blood loss, or certain medical conditions. It can bring fainting, a rapid pulse, and trouble concentrating.
Secondary POTS: Develops because of another condition, such as Ehlers-Danlos syndrome or an autoimmune disorder. Addressing that main condition is key.
How does the nervous system cause POTS symptoms?
Your autonomic nervous system controls everything you don’t have to think about: heart rate, blood pressure, digestion, and temperature. It has two main branches:
Sympathetic (“fight or flight”): Kicks in when you’re under stress. It raises heart rate and blood pressure and sends blood to your muscles.
Parasympathetic (“rest and regulate”): Helps your body recover. It slows your heart rate, supports digestion, and helps you relax.
In a healthy body, the two branches work together. When you stand up, your nervous system quickly adjusts blood flow and heart rate so enough blood reaches your brain.
With POTS, that balance is off. The nervous system doesn’t adjust properly when you stand, so heart rate climbs too high and other symptoms follow. This imbalance is called dysautonomia.
What does the vagus nerve have to do with POTS?
The vagus nerve is a key part of the rest-and-regulate system. It runs from the brainstem down to the abdomen and connects to many vital organs, helping control heart rate, digestion, and inflammation.
In POTS, the vagus nerve may be underactive or not working well. When that happens, it can’t balance out the fight-or-flight response, and the body stays stuck in overdrive. That can show up as a racing heart and dizziness when standing, along with digestive trouble, fatigue, and anxiety.
What causes POTS?
POTS can be triggered by many things. In our view, it usually comes from a buildup of stresses over time that wear down the nervous system and the vagus nerve. Contributors can include:
Viruses and infections: Illnesses like mono, Lyme disease, and COVID-19 can inflame the vagus nerve and affect how well it works.
Autoimmune and related conditions: Conditions like Ehlers-Danlos syndrome and mast cell activation syndrome involve inflammation that may affect the vagus nerve.
Long-term stress and trauma: Ongoing mental and emotional stress, especially early in life, can keep the body in fight-or-flight until the rest-and-regulate system is worn out.
Birth stress: A difficult delivery, including forceps, vacuum, or C-section, can strain the upper neck and brainstem area where the vagus nerve starts.
Posture and “text neck”: Constant forward head posture puts strain on the nerves and blood vessels in the neck. That’s one reason we think posture and spinal function belong in a POTS care plan, not just salt and fluids.
How does Invictus Chiropractic help people with POTS?
Rather than only managing symptoms, our goal is to find and address the nervous system imbalance underneath them and help the body get back to balance.
We start with INSiGHT scans. These scans measure how your nervous system is functioning and show areas of tension and imbalance that may be contributing to POTS symptoms. Repeating them over time lets us track progress and adjust your care plan.
We provide neurologically focused chiropractic care. Adjustments are aimed at reducing tension in the spine and nervous system, especially in the neck and upper back.
We support healthy habits. We also encourage:
Drinking more fluids and getting enough electrolytes
Staying active, with a focus on posture and stability
Good sleep habits
A clean diet with plenty of protein and healthy fats
Frequently asked questions about POTS
What is POTS?
POTS is a disorder of the autonomic nervous system that causes heart rate to rise by at least 30 beats per minute, or above 120, within 10 minutes of standing, without a drop in blood pressure.
What is the most common type of POTS?
Neuropathic POTS, which is tied to problems with the nerves that control heart rate and blood vessels.
Can POTS start after COVID-19?
Yes. Researchers have seen POTS develop in previously healthy people after COVID-19.
What is an INSiGHT scan?
An INSiGHT scan is a non-invasive test that measures how your nervous system is functioning, so your chiropractor can see areas of imbalance and track changes over time.
Is there a chiropractor in Cypress, TX who works with POTS patients?
Yes. Dr. Robert Pompella at Invictus Chiropractic, 11510 Barker Cypress Rd #125, provides neurologically focused chiropractic care for people with POTS.
Finding a path forward with POTS
Living with POTS can feel like having a phone with a worn-out battery. Some days it holds a charge, and other days it dies without warning. But once you understand the role the nervous system plays, there’s real reason for hope.
If you or someone you love is living with POTS, contact Invictus Chiropractic to schedule a consultation and INSiGHT scan. We’re at 11510 Barker Cypress Rd #125 in Cypress, TX.
This article is for educational purposes and isn’t medical advice. Talk with your doctor about your specific health questions.