POTS in Lyme Disease: An Autonomic Disorder
In the journal Cureus, Tahir and colleagues describe the symptoms and treatment of POTS, a condition often seen in Lyme disease patients that causes the heart rate to rise significantly upon standing.
According to the authors, POTS leads to an increase in heart rate of at least 30 beats per minute in adults and at least 40 beats per minute in children when standing from a recumbent position.
POTS symptoms in Lyme disease patients
The symptoms of POTS can affect multiple organ systems and significantly impair daily functioning.
According to Tahir, “POTS is an autonomic disorder characterized by symptoms such as palpitations, dyspnea, chest discomfort, lightheadedness, nausea, blurred vision, chronic fatigue, sleeping abnormalities, migraines, hypermobile joints, abdominal pain, irritable bowel, and bladder symptoms.”
Additional symptoms commonly reported by Lyme disease patients with autonomic dysfunction may include:
- brain fog
- exercise intolerance
- heat intolerance
- near-fainting episodes
- rapid heart rate
- poor concentration
- visual disturbances
Learn more about autonomic dysfunction in Lyme disease.
Why POTS may occur in Lyme disease
The mechanisms behind POTS remain complex and likely multifactorial.
According to Tahir, “POTS has heterogeneous pathophysiology, including excessive sympathetic stimulation, defective peripheral autonomic function, hypovolemia, or autoimmune dysfunction.”
Autonomic dysfunction has also been described in neurological disorders including:
- multiple sclerosis
- peripheral neuropathies
- movement disorders
- cerebrovascular disease
- dementia
In Lyme disease patients, inflammation, immune dysregulation, neuropathy, and small fiber nerve injury may contribute to orthostatic intolerance.
Learn more about small fiber neuropathy in Lyme disease.
Treatment approaches for POTS
Treatment strategies for POTS often include both non-pharmacologic and pharmacologic interventions.
Non-pharmacologic strategies may include:
- increasing hydration
- increasing salt intake
- wearing compression stockings
- gradual physical conditioning
- avoiding prolonged standing
Medications sometimes used to manage symptoms include:
- beta-blockers
- alpha-agonists such as Midodrine
- mineralocorticoids such as Fludrocortisone
- SSRIs and SNRIs
Other medications occasionally prescribed include pyridostigmine, desmopressin, and erythropoietin.
Ivabradine and POTS symptoms
Tahir’s review suggests that Ivabradine may help reduce heart rate in some POTS patients.
Ivabradine is FDA-approved under the brand name Corlanor for heart failure but is not specifically approved for POTS.
The medication may not appropriate for every patient.
Because autonomic symptoms vary widely, treatment plans often require individualized management.
POTS may overlap with neurologic Lyme symptoms
POTS symptoms can overlap substantially with neurologic Lyme disease.
Patients may report:
- fatigue
- dizziness
- brain fog
- lightheadedness
- exercise intolerance
- visual changes
- palpitations
This overlap may complicate diagnosis, particularly when symptoms fluctuate over time.
Learn more about neurologic Lyme disease.
Frequently Asked Questions
Can Lyme disease cause POTS?
Lyme disease has been associated with autonomic dysfunction and orthostatic intolerance in some patients.
What are common POTS symptoms?
Common symptoms include dizziness, rapid heart rate, fatigue, lightheadedness, palpitations, and brain fog.
Does POTS affect children with Lyme disease?
POTS can occur in both adults and children and may present differently depending on age and severity.
Can POTS symptoms fluctuate?
Yes. Symptoms often vary depending on hydration status, illness, stress, temperature, and physical activity.
How is POTS treated?
Treatment may include hydration, salt intake, compression garments, exercise conditioning, and medications tailored to symptoms.
Clinical Takeaway
POTS in Lyme disease may reflect underlying autonomic dysfunction involving cardiovascular, neurologic, and immune pathways.
Because symptoms overlap with fatigue, neurologic Lyme disease, and post-treatment symptom syndromes, careful evaluation is often necessary.
Recognizing orthostatic symptoms early may improve management strategies and quality of life for Lyme disease patients with autonomic dysfunction.
Related Articles
These related articles explore autonomic dysfunction, neurologic Lyme disease, cognitive impairment, and overlapping symptom syndromes.
Could autonomic dysfunction lead to pain in Lyme disease?
Could POTS and Lyme disease patients suffer from impaired cognitive function when standing?
What exactly is POTS – Postural tachycardia syndrome?
Lyme disease brain fog
Post-treatment Lyme disease syndrome
References
- Tahir F, Bin Arif T, Majid Z, Ahmed J, Khalid M. Ivabradine in Postural Orthostatic Tachycardia Syndrome: A Review of the Literature. Cureus. 2020;12(4):e7868.
- Xiong L, Leung TWH. Autonomic dysfunction in neurological disorders. Aging (Albany NY). 2019;11(7):1903-1904.
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.