01/24/2026
POTS (Postural Orthostatic Tachycardia Syndrome) isn’t just a heart-rate issue.
It’s a dysfunction of the autonomic nervous system — the system responsible for regulating heart rate, blood vessel tone, blood pressure, and blood flow when you change positions.
But here’s what most people are never told 👇
There are two very different pathways to POTS
Primary POTS
This is when the autonomic nervous system itself is the primary issue.
• No clearly identifiable disease causing the dysfunction
• Poor regulation of heart rate and vascular tone originates within the nervous system
• Often linked to past concussion, development, or subtle autonomic wiring issues
• Care focuses on autonomic regulation, neurological rehabilitation, and symptom control
➡️ In Primary POTS, the nervous system is the diagnosis.
Secondary POTS
This is when autonomic dysfunction is the result of something else.
• Another condition disrupts autonomic signaling
• POTS shows up as a downstream effect, not the root problem
• Common contributors include inflammation, autoimmunity, infections, neuropathy, connective tissue disorders, or metabolic stress
• Care must address both autonomic dysfunction and the underlying driver
➡️ In Secondary POTS, the nervous system is affected secondarily — not originally.
Why does this matter?
Because it changes how the nervous system should be evaluated.
It changes treatment strategy.
And it explains why symptom management alone often fails.
POTS isn’t one condition — it’s a pattern.
And patterns require precision, not guesswork.
Both are real.
Both are complex.
And both deserve proper neurological evaluation.
