POTS in Lyme disease is an autonomic disorder that causes the heart rate to rise by at least 30 beats per minute in adults, and at least 40 in children, when standing from a recumbent position. A review by Tahir and colleagues in Cureus describes the extensive symptoms and treatment options for this condition.
Symptoms of POTS in Lyme Disease
The symptoms extend far beyond heart rate. Tahir describes POTS as an autonomic disorder characterized by palpitations, shortness of breath, chest discomfort, lightheadedness, nausea, blurred vision, chronic fatigue, sleeping abnormalities, migraines, hypermobile joints, abdominal pain, irritable bowel, and bladder symptoms.
This multi-system presentation helps explain why the condition is frequently misdiagnosed. The wide range of symptoms often leads to fragmented evaluation rather than recognition of a single autonomic disorder.
How POTS Develops
POTS has heterogeneous pathophysiology. Tahir describes several contributing mechanisms including excessive sympathetic stimulation, defective peripheral autonomic function, hypovolemia, and autoimmune dysfunction.
Autonomic dysfunction has also been described in other neurological disorders including cerebrovascular disease, movement disorders, dementia, multiple sclerosis, and peripheral neuropathies. In Lyme disease, infection-driven inflammation and autonomic dysfunction may trigger the same mechanisms.
Treatment of POTS
Tahir describes both non-pharmacologic and pharmacologic approaches to treating this autonomic disorder.
Non-pharmacologic strategies include increasing hydration, increasing salt intake, and wearing compression stockings, all aimed at improving blood volume and reducing venous pooling.
Pharmacologic options include beta-blockers, alpha-agonists such as midodrine (which stimulates peripheral vasoconstriction), mineralocorticoids such as fludrocortisone (which promotes salt and water retention), and selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs).
Tahir’s review also suggests that ivabradine, an FDA-approved heart failure medication, may be effective for reducing heart rate. However, it is not FDA-approved for POTS specifically.
Clinical Takeaways
POTS in Lyme disease is a multi-system autonomic disorder with heterogeneous pathophysiology including sympathetic overstimulation and autoimmune dysfunction. Treatment includes non-pharmacologic strategies like hydration and compression plus pharmacologic options targeting heart rate and vascular tone.
Frequently Asked Questions
What is POTS in Lyme disease?
POTS is an autonomic disorder causing heart rate to rise 30+ beats per minute upon standing, triggered by infection-driven dysfunction.
What are the symptoms of POTS?
Symptoms include palpitations, lightheadedness, fatigue, nausea, chest discomfort, blurred vision, migraines, and gastrointestinal problems affecting multiple body systems.
How is POTS in Lyme disease treated?
Treatment combines hydration, salt intake, compression stockings, beta-blockers, midodrine, fludrocortisone, and sometimes SSRIs or ivabradine for heart rate control.
References
- Tahir F, Bin Arif T, Majid Z, et al. 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.
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.