POTS and Lyme Disease: Why Symptoms Are Often Missed

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 physiologic problem.

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

This page focuses on why POTS in Lyme disease is often missed or misdiagnosed. For a full overview of symptoms, standing intolerance, and adrenaline-type episodes, see POTS in Lyme disease.

Importantly, POTS is often misdiagnosed as anxiety, delaying recognition of an underlying autonomic disorder in patients with Lyme disease.

Autonomic symptoms may develop gradually and are often part of a broader evolving pattern. Learn more about delayed Lyme disease diagnosis.

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

The cause of postural orthostatic tachycardia syndrome is not fully understood, but it is likely multifactorial and may involve autonomic dysfunction, vascular changes, and immune factors.

In some patients, these 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.

For a broader overview of multisystem symptom patterns, see our Lyme Disease Symptoms Guide.

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Why POTS Symptoms Are Often Missed

POTS is frequently overlooked because standard cardiac and neurologic tests may appear normal. Symptoms are often attributed to anxiety, stress, or deconditioning.

However, when symptoms follow a pattern—worse when standing and better when lying down—they may reflect an underlying autonomic disorder rather than a primary psychiatric condition.

This contributes to delays in diagnosis and appropriate care, particularly in patients with complex multisystem illness.

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POTS and Lyme Disease

POTS has been described in patients following Lyme disease, suggesting a potential link between infection, immune response, and autonomic dysfunction.

Patients may experience:

• Fatigue
• Brain fog or slowed thinking
• Palpitations or rapid heart rate
• Dizziness or near-fainting when standing

In many cases, symptoms worsen when upright due to reduced blood flow to the brain, a hallmark of autonomic dysfunction.

These symptoms often overlap with patterns seen in neurologic Lyme disease, particularly when brain fog or cognitive slowing is present.

Patients who first notice lightheadedness or unsteadiness may also relate to our page on dizziness in Lyme disease, especially when symptoms are triggered by standing.

Key Point: Symptoms that worsen with standing may reflect POTS rather than anxiety.

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Concurrent Medical Conditions in POTS

Patients with POTS frequently have coexisting medical conditions, including irritable bowel syndrome (IBS), food intolerance, and allergic sinusitis.

Hypermobility syndromes, often referred to as Ehlers-Danlos syndrome, are also overrepresented in patients with POTS.

Symptoms may overlap with chronic fatigue syndrome and fibromyalgia, further complicating diagnosis.

Patients with persistent or complex symptoms may benefit from evaluation by a Lyme disease specialist.

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Treatment Options for POTS

Treatment of POTS is primarily focused on symptom management. Strategies may include increasing blood volume, improving vascular tone, and controlling heart rate.

Fludrocortisone may be used to increase blood volume, while midodrine can help address peripheral venous pooling. Low-dose propranolol may reduce elevated heart rate.

Despite these options, treatment remains challenging, and many patients continue to experience persistent symptoms.

Symptoms such as fatigue, dizziness, and brain fog are also discussed in our Lyme Disease Symptoms Guide.

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Clinical Takeaway

POTS is a complex form of autonomic dysfunction that may follow infections, including Lyme disease.

Symptoms such as fatigue, dizziness, palpitations, and brain fog often reflect impaired regulation of blood flow and nervous system signaling.

Recognizing POTS in Lyme patients is critical, as these symptoms are frequently misattributed to anxiety or deconditioning.

When symptoms worsen with standing and improve with rest or lying down, it may be helpful to consider both POTS in Lyme disease and the broader framework of autonomic dysfunction in Lyme disease.

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Frequently Asked Questions

What causes POTS?
POTS may be caused by autonomic dysfunction, increased sympathetic activity, deconditioning, and possibly immune-related factors.

Can Lyme disease trigger POTS?
Yes. POTS has been reported in patients following Lyme disease, often with fatigue, cognitive dysfunction, and orthostatic intolerance.

Why do symptoms get worse when standing?
Standing can worsen symptoms because the body has difficulty regulating circulation, leading to reduced blood flow to the brain and increased heart rate.

How is POTS treated?
Treatment focuses on symptom management, including increasing blood volume, improving vascular tone, and controlling heart rate.

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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