Can Lyme Disease Cause POTS? Symptoms and Diagnosis

POTS causes dizziness, rapid heart rate, and fatigue, especially when standing
Lyme disease has been associated with POTS in some patients
Recognizing the autonomic pattern may improve diagnosis

POTS and Lyme disease may be linked through autonomic dysfunction. Many patients experience symptoms such as dizziness, fatigue, brain fog, and a rapid heart rate, especially when standing.

These symptoms are often misunderstood or attributed to anxiety, even when they reflect an underlying disorder of autonomic nervous system function.

Key pattern: symptoms that worsen when standing and improve when lying down are a hallmark of POTS.

This page focuses on recognizing POTS in patients with Lyme disease. For a more comprehensive discussion of standing intolerance, autonomic dysfunction, and treatment options, see POTS in Lyme disease.

POTS is a form of autonomic dysfunction that may develop after infections, including Lyme disease.

POTS is generally defined by a sustained increase in heart rate of at least 30 beats per minute in adults or 40 beats per minute in adolescents within 10 minutes of standing, without orthostatic hypotension. Patients with Lyme disease may also experience broader forms of autonomic dysfunction and orthostatic intolerance that do not meet the formal diagnostic criteria for POTS but produce many of the same symptoms.

The exact cause of postural orthostatic tachycardia syndrome is not fully understood. Proposed mechanisms include autonomic dysfunction, abnormal blood vessel regulation, hypovolemia, immune dysregulation, and excessive sympathetic nervous system activity.

In some patients with Lyme disease, symptoms may reflect underlying mechanisms such as immune activation, neuroinflammation, and nervous system dysregulation. Learn more about the causes of long-term Lyme disease symptoms.

Why POTS Symptoms Are Often Missed

POTS is frequently overlooked because routine cardiac and neurologic testing may appear normal. Patients are often told that their symptoms are caused by anxiety, stress, panic attacks, or simple deconditioning.

However, when symptoms consistently worsen after standing and improve with sitting or lying down, they may reflect an underlying autonomic disorder rather than a primary psychiatric condition.

This contributes to delays in diagnosis and appropriate treatment, particularly in patients with complex multisystem illnesses such as Lyme disease.

Learn more about delayed Lyme disease diagnosis.

Can Lyme Disease Cause POTS?

POTS has been reported following Lyme disease, suggesting that infection-related immune activation or nervous system dysfunction may contribute to autonomic symptoms in susceptible individuals.

Although published evidence consists primarily of case reports and small case series, these reports support considering POTS in patients who develop persistent orthostatic symptoms after Lyme disease.

Patients may experience:

• Fatigue
• Brain fog or slowed thinking
• Palpitations or rapid heart rate
• Dizziness or near-fainting after standing
• Exercise intolerance
• Lightheadedness that improves after lying down

In many cases, symptoms worsen when upright because of impaired regulation of blood flow and autonomic nervous system signaling.

These symptoms frequently overlap with neurologic Lyme disease, particularly when cognitive dysfunction, dizziness, or balance problems are present.

Key point: Orthostatic symptoms that consistently worsen while standing deserve evaluation for POTS or another form of autonomic dysfunction rather than being attributed to anxiety alone.

Associated Medical Conditions

POTS frequently occurs alongside other medical conditions that may contribute to symptoms or complicate diagnosis. Common associated disorders include irritable bowel syndrome (IBS), migraine headaches, mast cell activation, allergic disorders, chronic fatigue syndrome, fibromyalgia, and hypermobility syndromes such as Ehlers-Danlos syndrome.

These overlapping conditions can make it difficult to determine whether dizziness, fatigue, gastrointestinal symptoms, or cognitive dysfunction are due to POTS alone or reflect multiple contributing disorders.

Patients with Lyme disease often have similarly complex presentations, making a comprehensive clinical evaluation especially important.

Treatment Options for POTS

Treatment focuses on improving symptoms and daily function rather than curing the disorder. Management typically combines lifestyle measures with medications tailored to the individual’s symptoms.

Initial non-pharmacologic strategies may include:

• Increasing fluid intake
• Increasing dietary salt when medically appropriate
• Using compression stockings or abdominal compression garments
• Gradually increasing physical activity with individualized exercise programs
• Avoiding prolonged standing whenever possible

When symptoms remain significant, medications may be considered. Common options include fludrocortisone to expand blood volume, midodrine to improve vascular tone, and low-dose beta-blockers to reduce excessive heart rate.

Pyridostigmine may benefit selected patients. Ivabradine (Corlanor) has also shown promise in recent studies by lowering heart rate without substantially reducing blood pressure. Although ivabradine is FDA approved for certain patients with heart failure, it is not FDA approved specifically for POTS.

A 2025 systematic review concluded that ivabradine, beta-blockers, and midodrine currently have the strongest available published evidence among oral pharmacologic therapies for POTS, although treatment should remain individualized.

Frequently Asked Questions

Can Lyme disease cause POTS?

POTS has been reported after Lyme disease in some patients, although the precise relationship remains under investigation. Lyme disease may also be associated with broader autonomic dysfunction and orthostatic intolerance.

What symptoms suggest POTS?

Common symptoms include dizziness, rapid heart rate after standing, fatigue, brain fog, exercise intolerance, lightheadedness, and near-fainting that improve after sitting or lying down.

Can Lyme disease cause dizziness when standing?

Yes. Some patients with Lyme disease develop autonomic dysfunction or POTS, which may cause dizziness, lightheadedness, or rapid heart rate after standing.

Is POTS the same as autonomic dysfunction?

No. POTS is one form of autonomic dysfunction. Some patients with Lyme disease experience broader autonomic dysfunction or orthostatic intolerance without meeting the formal diagnostic criteria for POTS.

How is POTS treated?

Treatment generally combines increased hydration, salt intake when appropriate, compression garments, individualized exercise, and medications such as fludrocortisone, midodrine, beta-blockers, pyridostigmine, or other therapies based on the patient’s clinical presentation.

Clinical Takeaway

POTS is one form of autonomic dysfunction that may develop following Lyme disease and other illnesses. Recognizing the characteristic pattern of orthostatic symptoms can help distinguish POTS from anxiety and other conditions that produce similar complaints.

Recognizing orthostatic symptoms early allows clinicians to evaluate patients for POTS or other forms of autonomic dysfunction and develop an individualized treatment plan that can improve daily function and quality of life.

Related Articles

Brain Fog and Lyme Disease
Recovery from Lyme Disease
Causes of Long-Term Lyme Disease Symptoms
Delayed Lyme Disease Diagnosis

References

1. Wells R, Spurrier AJ, Linz D, et al. Postural tachycardia syndrome: current perspectives. Vasc Health Risk Manag. 2018;14:1-11.
2. Kanjwal K, Karabin B, Kanjwal Y, Grubb BP. Postural orthostatic tachycardia syndrome following Lyme disease. Cardiol J. 2011;18(1):63-66.
3. 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.
4. Schiweck N, Langer K, Maier A, et al. Oral medications for the treatment of postural orthostatic tachycardia syndrome: a systematic review. Clin Auton Res. 2025.

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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