What is POTS?

Postural orthostatic tachycardia syndrome (POTS), a type of orthostatic hypotension, is a debilitating form of dysautonomia (learn more).  In order to properly understand this condition, it is important to know that your brain controls where your blood goes and what combination of body adaptations are needed to accomplish the task. Our brain decides how to allocate blood to various body parts based on demand, while at the same time, executing its most important job of supplying itself with ample blood and oxygen at all times.  Our bodies do not hold enough blood to completely fill all of our blood vessels simultaneously. When we move a part of our body, our brain must shunt additional blood to that region to supply more necessary blood and oxygen. It is the nervous system’s responsibility to determine when and where extra blood must be sent so that you can safely sit, stand, and move while also keeping the appropriate amount of blood in your brain. With POTS, your nervous system has lost its ability to maintain this process. This is why we often see an excess or pooling of blood in the limbs when standing and sitting. In many cases, there is not enough blood returning to the heart and the brain. When the brain recognizes that it is not getting enough blood/oxygen, it causes the heart to beat faster (tachycardia) in an attempt to overcome the deficit. The heart can beat so fast that the lower chamber can’t fill appropriately, preventing the adequate amount of blood from getting pumped to the brain and body. Since the brain has the highest demand for oxygen, it suffers the most when the output from the heart is decreased. This is why POTS patients always feel tired, get dizzy, etc. So, in an attempt to make the problem better by increasing the heart rate, the dysfunctional nervous system actually makes the problem worse. These are general examples of typical POTS symptoms. The disorder can manifest itself in many different ways.

Sad skinny anorectic girl and bottle of water

How is POTS typically diagnosed?

Unfortunately, this form of dysautonomia is not typically diagnosed in a timely manner. A 2013 survey of over 700 patients diagnosed with POTS conducted by Dysautonomia International revealed the following difficulties in obtaining an accurate diagnosis and receiving any treatment (1):

  • The average diagnostic delay for a POTS patient is 5 years and 11 months.
  • Only 25% of patients are diagnosed within the first year of symptoms.
  • 50% of patients traveled more than 100 miles from home to receive POTS related medical care.
  • Prior to being diagnosed with POTS, 59% of patients were told by a doctor that their symptoms were "all in your head."
  • Prior to being diagnosed with POTS, 69% of POTS patients were diagnosed with an anxiety disorder. However, peer-reviewed research demonstrates that POTS patients are no more likely to be anxious than the general public.
  • 27% of patients visited more than 10 doctors for their symptoms before finally being diagnosed with POTS

These statistics are why people seek care from our clinic. We understand POTS as a nervous system disorder and treat the individual parts of the brain that are behind the fatigue, dizziness, fainting, elevated heart rate, etc.

How is POTS typically treated?

Often patients are prescribed increased amounts of water and salt consumption in an attempt to create more fluid volume in the system. Compression socks, rest and graded exercise are often suggested as well. Medication is sometimes used to treat symptoms. (2)

How do the Innova Brain doctors diagnose POTS?

Very specific functional assessments are used to examine your brain, the main controller of blood flow. Our diagnostic testing and neurological examination uncover dysfunction within the brain stem, cerebellum, cerebral cortex, spinal cord and deep brain structures. The entire autonomic nervous system is studied, as well as the affected organs and corresponding systems causing your symptoms - leaving no stone uncovered. If driving in the car makes you nauseous, which part of the vestibular system is malfunctioning?  We go beyond your symptoms to understand and target the cause of the issue. If you’ve had the traditional testing and treatment for POTS and are still experiencing symptoms, it’s time for more in-depth testing.

How is POTS treated at Innova?

Our battery of diagnostics provides an understanding of the specific brain areas that are not functioning properly. With this information the doctor develops a precise plan of targeted and appropriate rehabilitation specific to your brain. Through the concept of neuroplasticity, the doctors work to rewire the neurological structures within your brain. Rehab strategies include stimulation of targeted brain areas using movement, sound, light, visual exercises and several other modalities. Our therapies are safe, non-invasive, and unique to each individual. 

There are thousands of types and combinations of therapies that can be used to assist the brain in rewiring itself. The rehabilitation protocol that you will receive will be based on your precise needs. Treatment may come in many different forms. Years of training and experience by our doctors allow them to make the best and safest choices for your recovery process. The goal of your rehabilitation is to repair your nervous system so that your brain can begin to control the “automatic” functions of your entire body.

Are you a good candidate for POTS treatment at Innova?

A phone or in-person consultation will allow our doctors to learn about your case and determine if you are a good fit. We accept patients on a case by case basis after the consultation, review of records and a step by step screening. If distinct areas of brain dysfunction are found during the assessment and the doctors see signs that your neurology has the ability to be positively influenced, we will recommend you for individualized treatment at Innova Brain. Call to schedule your complimentary consultation.


  1. Diagnostic Delay in POTS, Dysautonomia International
  2. Postural Orthostatic Tachycardia Syndrome (POTS), Dysautonomia International

Additional Resources:

What is Dysautonomia? Dysautonomia International

Van der Zalm T, Alsma J, van de Poll SWE, Wessels MW, Riksen NP, Versmissen J, Postural orthostatic tachycardia syndrome (POTS): a common but unfamiliar syndrome, Neth J Med. 2019 Jan;77(1):3-9

A new approach to POTS

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