Adrenaline Surges in POTS: Why Your Body Feels on Edge
Adrenaline surges in POTS are a symptom pattern described by patients as sudden episodes of rapid heart rate, shakiness, and internal overstimulation that can feel similar to anxiety—but often occur without an emotional trigger.
Many patients refer to these episodes as “adrenaline dumps.” While this is not a formal medical diagnosis, it reflects periods of increased sympathetic nervous system activity.
These symptoms are commonly seen in POTS in Lyme disease, where autonomic dysfunction affects circulation and nervous system regulation.
Key pattern: symptoms may occur when standing, after exertion, or at night—and often improve with rest or lying down.
For a broader overview of symptoms, see our Lyme Disease Symptoms Guide.
What Do Adrenaline Surges Feel Like?
Patients often describe these episodes as sudden and difficult to predict. Common features include:
- Rapid heart rate or pounding heartbeat
- Internal trembling or shaking
- A sense of anxiety without a clear cause
- Feeling “on edge” or overstimulated
- Difficulty falling asleep or waking with a racing heart
These symptoms may be brief or prolonged and may occur repeatedly.
Some patients first recognize these patterns in the context of dizziness in Lyme disease, particularly when symptoms are triggered by standing.
Why Adrenaline Surges Occur in POTS
POTS is a disorder of autonomic dysfunction, where the body has difficulty regulating heart rate, blood pressure, and blood flow.
When standing, blood may not circulate efficiently, leading to reduced blood flow to the brain. The body compensates by activating the sympathetic nervous system—its “fight or flight” response.
In some patients, this response becomes exaggerated. This can lead to symptoms often described as adrenaline surges, including rapid heart rate, internal shaking, and a sense of overstimulation.
In some cases, this pattern may reflect hyperadrenergic POTS, a subtype of POTS characterized by increased sympathetic nervous system activity.
Recent research has increasingly linked Lyme disease with autonomic dysfunction and POTS. Infection may affect small nerve fibers, disrupt blood flow regulation, and trigger compensatory increases in sympathetic activity.
These symptoms may overlap with patterns seen in neurologic Lyme disease, particularly when brain fog or sensory changes are present.
Reference: Adler BL, et al. Dysautonomia following Lyme disease. Frontiers in Neurology. 2024.
Adrenaline Surges vs Anxiety
These episodes are frequently mistaken for anxiety or panic attacks. However, several features may help distinguish them:
- Symptoms triggered by standing or physical stress rather than emotional stress
- Episodes may occur suddenly without psychological triggers
- There is often a pattern of fatigue, brain fog, dizziness, or palpitations
- Symptoms may improve when lying down
This can contribute to delayed Lyme disease diagnosis when underlying autonomic disorders are not recognized.
Adrenaline Surges at Night
Some patients report waking suddenly with a racing heart, internal shaking, or a sense of panic.
These nighttime episodes may reflect ongoing autonomic instability and can significantly disrupt sleep.
Related Symptoms That Often Occur Together
Adrenaline surges rarely occur in isolation. Patients may also experience:
Together, these symptoms may point toward POTS in Lyme disease rather than isolated anxiety or stress.
Clinical Takeaway
Common but misunderstood: Adrenaline surges are a frequent symptom pattern in POTS.
Not a formal diagnosis: The term “adrenaline dump” reflects patient experience but corresponds clinically to increased sympathetic activation.
Mechanism matters: Autonomic dysfunction, small fiber nerve involvement, and impaired blood flow regulation may all contribute.
Next steps: Recognizing these symptoms as part of POTS may help guide more accurate diagnosis and management. For a broader clinical overview, see POTS in Lyme disease.
Frequently Asked Questions
What is an adrenaline surge in POTS?
It refers to a sudden increase in sympathetic nervous system activity, causing symptoms such as rapid heart rate, shakiness, and anxiety-like sensations.
Are adrenaline surges the same as panic attacks?
Not always. In POTS, these episodes are often triggered by physiologic factors such as standing rather than emotional stress.
Can Lyme disease lead to POTS symptoms?
Emerging research suggests that Lyme disease may contribute to autonomic dysfunction in some patients.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
