POTS: Autonomic Dysfunction, Overlapping Conditions, and Lyme Disease

The cause of postural orthostatic tachycardia syndrome (POTS) is not fully understood,
but researchers believe it is multifactorial. According to Wells and colleagues,
“moderate autonomic dysfunction, increased sympathetic tone, severe deconditioning,
inadequate venous return, or excessive venous pooling may contribute to POTS symptoms.”

In addition, “autoimmunity and mast cell activation syndromes have been postulated as
contributing to the development of POTS in some patients, but immunotherapy is rarely
indicated, and the relevance of autoantibodies and mast cells in most patients with POTS
remains controversial,”

writes Wells.

Concurrent Medical Conditions in POTS

Patients with POTS frequently have coexisting medical conditions. Symptoms consistent
with irritable bowel syndrome (IBS), food intolerance, and allergic sinusitis are commonly
reported, according to Wells.

Notably, “treatment of POTS may improve IBS symptoms, as seen in a cohort of children
treated with fludrocortisone.” In addition, “concurrent hypermobility—often referred to
as Ehlers-Danlos syndrome—is overrepresented in patients with POTS,” writes Wells.

Symptoms of POTS also overlap with those seen in chronic fatigue syndrome and
fibromyalgia. Wells and colleagues did not specifically address the association between
POTS and Lyme disease in their review.

POTS and Lyme Disease

Postural orthostatic tachycardia syndrome has, however, been described in patients treated
for Lyme disease.

Kanjwal and colleagues

reported several such cases in their article,
“Postural orthostatic tachycardia syndrome following Lyme disease.”

Five patients with Lyme disease and POTS “were ill with fatigue, cognitive dysfunction,
orthostatic palpitations, and either near syncope or frank syncope,” the authors reported.

“Three patients were also suffering from migraines, two from anxiety and depression,
and one from hypertension,” they noted.

“The debilitating nature of these symptoms had resulted in a loss of employment or
inability to attend school.”

Treatment Options for POTS

Treatment options for POTS remain limited. “Available therapies for this condition are
directed toward symptom control by either increasing intravascular volume, increasing
peripheral vascular tone, or controlling heart rate (HR),” writes Wells.

“Fludrocortisone is a reasonable option for increasing intravascular volume, while
midodrine may be useful in patients with peripheral venous pooling,” Wells explains.
In addition, “nonselective β2 antagonists such as low-dose propranolol may be effective
for treating elevated heart rate.”

Editor’s note:
In my clinical experience, treating Lyme disease and associated co-infections can be
effective in alleviating POTS symptoms in some patients.