POTS in Lyme Disease: Why Standing Causes Symptoms
Can Lyme disease cause POTS? In some patients, infection may trigger autonomic dysfunction, leading to symptoms consistent with postural orthostatic tachycardia syndrome (POTS).
Quick Answer: POTS in Lyme disease is a form of autonomic dysfunction where heart rate rises abnormally upon standing, often causing dizziness, fatigue, and brain fog.
Clinical Insight: These symptoms are frequently misdiagnosed as anxiety before autonomic dysfunction is recognized.
POTS in Lyme disease reflects a broader pattern of dysregulation affecting heart rate, blood pressure, and circulation. :contentReference[oaicite:0]{index=0}
For a full overview, see POTS in Lyme disease.
This condition typically involves an increase in heart rate of at least 30 beats per minute in adults (40 in children) when moving from lying down to standing.
This pattern is commonly seen in Lyme disease misdiagnosis, where symptoms such as palpitations or dizziness are often attributed to anxiety before the underlying cause is identified.
Symptoms of POTS in Lyme Disease
POTS affects multiple body systems—not just heart rate.
- Palpitations
- Shortness of breath
- Chest discomfort
- Lightheadedness or dizziness
- Nausea
- Blurred vision
- Chronic fatigue
- Sleep disturbances
- Migraines
- Hypermobility in some patients
- Abdominal pain or IBS-like symptoms
- Bladder dysfunction
Many patients also experience cognitive symptoms such as slowed thinking, difficulty concentrating, and brain fog in Lyme disease.
Symptoms often worsen when standing or with exertion.
This overlaps with exercise intolerance in Lyme disease, where the body struggles to tolerate activity.
Many patients see multiple specialists before the pattern is recognized.
Why Lyme Disease Causes Dizziness When Standing
Dizziness occurs because autonomic dysfunction disrupts normal circulation.
When standing, blood may pool in the lower body instead of returning efficiently to the heart and brain.
This reduces cerebral blood flow and leads to:
- Dizziness
- Blurred vision
- Weakness
- Fatigue
- Near-fainting
This cluster of symptoms is known as orthostatic intolerance.
These patterns are commonly seen in autonomic dysfunction in Lyme disease.
How POTS Develops
POTS has a complex and heterogeneous pathophysiology.
Proposed mechanisms include:
- Excess sympathetic activation
- Peripheral autonomic nerve dysfunction
- Low blood volume (hypovolemia)
- Autoimmune processes
In Lyme disease, infection-driven inflammation and immune activation may disrupt autonomic regulation.
These symptoms may reflect interacting persistent Lyme disease mechanisms, including immune dysregulation and nervous system instability.
Treatment of POTS
Treatment focuses on improving circulation, stabilizing autonomic function, and reducing excessive heart rate responses.
Non-Pharmacologic Strategies
- Increasing hydration
- Increasing salt intake
- Wearing compression stockings
- Gradual physical reconditioning when tolerated
These measures form the foundation of treatment.
Pharmacologic Options
- Beta-blockers
- Alpha-agonists (midodrine)
- Mineralocorticoids (fludrocortisone)
- SSRIs or SNRIs
Ivabradine may reduce heart rate in selected patients.
In Lyme disease, treatment may also include addressing underlying infection or coinfections contributing to autonomic dysfunction.
Clinical Takeaway
POTS in Lyme disease is a multi-system autonomic disorder.
Symptoms often include dizziness, palpitations, fatigue, and brain fog.
These symptoms are frequently misdiagnosed.
Recognizing autonomic dysfunction can explain otherwise unexplained symptoms and guide treatment.
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
Do we see resolution of POTS with treatment of Lyme disease or is this damage done?
I often see marked improvements in my practice if the cause is a tick borne illness.
I often see marked improvements in my practice if the cause is a tick borne illness.
Yes. I have a patient with POTS who also has lyles disease which I am treating manually (MLD) to the cervical and occipital lymph vessels which accelerates cerebral spinal fluid exit into nasal mucosa and spinal meninges
Dear Dr. Cameron,
The first diagnosis I received in regards to my maladies was Hashimoto’s Thyroiditis, 1986. Followed by Endometriosis, 2003, CFS 2006, Adnomyosis 2006 (full hysterectomy 06/2006) never recovered. 2012 hospitalized for 10 days, 2.3 Hemoglobin. Received 50 Blood Transfusions, still no diagnosis. 17 Root Canals, all failed. Tonsillectomy 2013. Finally 08/2013 tested for Bb, Western Blot ~ Positive for Lyme Disease. 2013 w/Dr. R. Stricker testing & treatment for Bb pos, Babesia pos, Ehrlichia pos. via IGeneX. Presently still displaying symptoms. Testing w/Internist via Quest Diagnostics. New results as follows: LYME AB SCREEN
View trends Index value >0.90. My Question: Do I or should I request additional testing?? Per Website: If Lyme Disease Antibody Screen is ≥0.90, then Lyme Disease Antibodies (IgG, IgM), Immunoblot will be performed at an additional charge (CPT code(s): 86617 x2). I do not believe an Immunoblot was ordered or performed. Your thoughts? Which direction should I proceed? Should tests be performed through IGeneX? My state is governed by IDSA Rules and Regulations. Thank you, Dr. Cameron, you are a blessing and a hero to so many.
Do we see resolution of POTS with treatment of Lyme disease or is this damage done?
My 12 year old has all of these symptoms but was treated for Lyme disease 3 years ago. Could it be this? Her symptoms are palpitations, dyspnea, chest discomfort, lightheadedness, nausea, blurred vision, chronic fatigue, sleeping abnormalities, migraines, hypermobile joints, abdominal pain. And she’s also getting muscle twitches. Her doctors brush off the Lyme because she was treated but all of her testing is coming back good.
I have patients in my practice who have benefited from retreatment for a tick borne illness. I have had these patients be sure there is not another illness.
I have patients in my practice who are doing well after re-treatment for a tick borne infection despite being previously treated. They often have a number of what initially was thought to be unrelated conditions. Of course, they need to be evaluated for other illnesses.
I have hereditary alpha tryptasemia, and my son was just diagnosed with lyme/ co infection of ebv with a wonderful functional med dr you work with ( Dr G Brown. )I have noted cyanosis on my sons legs , along with the brain fog and fatigue , bp at 90/50 .Would like to take him for valsalva /qsart/ tilt but the local hospital here won’t even recognize the lyme . Do you do autonomic testing or know a Lyme friendly autonomic specialist. I’m not sure where the appropriate place to go for lyme related dysautonomia eval would be . Happy to come to NY. …
I have young patients with tick borne illnesses whose autonomic illness can be quite ill with autonomic issues. Some of them get better with treatment with antibiotics. I have had to treat some of them for autonomic issues at the same time. I do not do a tilt table in my office.
I was recently diagnosed with POTS after being hospitalized being tachicardic (heart rates of 150-160 dropping to 60s/70s in seconds). I have a family cardiac history of my father passing from a heart attack at 53 and mother had a heart attack and triple bipass. I have previous diagnosis of Lyme, babesia, parasites, ebv, bartonella, low hormone levels, heavy metal toxicity and mold. Also previous kidney infection and current bilateral stones. I started a beta blocker metoprolol and had horrible side effects though it worked for improving my heart rate I recently had to stop taking. Do you have any suggestions for medication that has worked well for Lyme patients with pots?
I have Lyme disease patients who have POTS. I do not have any new medications. I have patients whose response to medications for POTS improved when their Lyme disease was treated.
I have chronic Lyme, dysautonomia, lupus, gastroparesis and biliary dyskinesia…I have been living with this a very long time…I have had five bullseye rashes in twenty years time and recently bitten again last summer and symptoms got extremely worse..I’m trying to take supplements because I can’t afford a LLMD right now
What came first? Did Lyme disease cause your dysautonomia?
My son has POTS. EDS. MCAS I have people argue with me that it’s not that it’s JUST LYMES. I beg to differ. Your thoughts??
I have patients who fit more than one diagnostic criteria. They typically see more than one specialists during their evaluation and treatment.