Conditions we treat
POTS and dysautonomia
For patients whose nervous system struggles to control heart rate and blood flow when they stand up, especially those who have been dismissed or told to just drink more water. POTS is very treatable.
See it
What standing up does to heart rate and blood pressure
Lying down, a resting heart rate around 60 is typical.
Watch both numbers. In POTS, heart rate climbs 40 or more beats per minute within 10 minutes of standing in teens ages 12 to 19 (30 or more in adults) while blood pressure holds steady, with symptoms for at least 3 months. Dehydration usually looks different: blood pressure tends to fall.
Illustration only. Diagnosis needs a proper standing test or tilt test, done by a clinician.
What it is
Dysautonomia is a problem with the autonomic nervous system, the part of your nervous system that runs the things you don’t think about: heart rate, blood pressure, digestion, temperature, and more.
POTS (postural orthostatic tachycardia syndrome) is one of the most common forms. It isn’t simple dehydration. It comes from a complex interaction in how the nervous system controls the heart and blood vessels: vessels don’t tighten the way they should when you stand, blood pools in the legs and belly, and the heart races to compensate. Fluids and salt help, but they’re only one piece.
POTS most often affects teens and young adults, especially young women. It can start after a viral illness or a concussion, and it is often missed for years. The good news is that it is very treatable, and most young people improve a great deal with the right plan.
Common symptoms we treat
- Lightheadedness, dizziness, or fainting when standing
- Rapid or pounding heart rate
- Extreme fatigue and exercise intolerance
- Brain fog
- Temperature dysregulation and excessive sweating
- Nausea and gut symptoms
How we approach it
Dysautonomia rarely travels alone. It commonly comes with chronic fatigue, migraine, lingering concussion symptoms, hypermobile connective tissue disorders, IBS, and anxiety.
We treat all of it as one connected picture, not separate problems that each need a separate specialist. We don’t manage POTS with invasive treatments like routine IV fluid infusions or ports. We focus on treatments that help the body regulate itself and last.
We also look at what keeps the nervous system revved up: stress, sleep, and diet all feed autonomic activation. And when planning, organizing, and follow-through are hard, it’s much harder to keep up with fluids, meals, sleep, and activity, and everyday stress runs higher. That isn’t a willpower problem. It’s a common, treatable piece of POTS, and we screen for it.
- Confirming the diagnosis with a careful standing evaluation
- Looking for what’s driving it, including hypermobility, a recent illness or concussion, and stress, sleep, and diet patterns that keep the nervous system revved up
- Screening for executive function and attention challenges that make routines and stress harder to manage, and treating them
- Fluid, salt, and compression strategies matched to the patient
- Medications to support blood volume, blood vessel tone, and heart rate, matched to each patient
- Vagus nerve treatments, including noninvasive vagus nerve stimulation
- Autonomic rehabilitation with our occupational therapist
- Biofeedback and autogenic relaxation training to calm an overactive stress response
- A paced, realistic return to activity and school
- Treating overlapping migraine, fatigue, and gut symptoms together
- Treating overlapping mental health difficulties, including anxiety, depression, and PTSD
Often travels with
These often show up together. We treat them as one picture.
Questions families ask
Isn’t POTS just dehydration?
No. Dehydration can make POTS symptoms worse, and low fluid on its own can raise heart rate, so we check for it. But POTS is a problem in how the nervous system controls the heart and blood vessels. Blood pressure usually holds steady while heart rate climbs, and symptoms continue even when fluids are good. That’s why it needs more than water and salt.
How is POTS diagnosed?
With a standing test or tilt-table test. Heart rate and blood pressure are measured lying down and then repeatedly over 10 minutes of standing. POTS means a sustained rise of 40 or more beats per minute in teens ages 12 to 19 (30 or more in adults), without a significant drop in blood pressure, plus symptoms when upright that have lasted at least 3 months.
Is POTS just anxiety?
No. POTS is a measurable problem with how the autonomic nervous system regulates heart rate and blood flow on standing. A racing heart can feel like anxiety, and anxiety can coexist with POTS, which is one reason we look at the whole picture instead of picking one label.
Can POTS get better?
Yes. POTS is very treatable, and most young people improve substantially with the right plan, though recovery is usually gradual. Addressing the things that keep it going, like deconditioning, poor sleep, low fluid and salt intake, and overlapping conditions, matters as much as any single medication.
Do you use IV fluids or ports for POTS?
No. We don’t manage POTS with invasive treatments like routine IV fluid infusions or ports, which carry real risks such as infections and blood clots. We focus on fluids and salt by mouth, compression, medications, vagus nerve treatments, autonomic rehabilitation, and biofeedback and relaxation training that help the body regulate itself.
Do you see younger children with dizziness or fainting?
Yes. The formal POTS heart-rate criteria are defined for ages 12 and up, but younger children can have similar symptoms, and we evaluate them as well.
Heart-rate criteria from the 2015 Heart Rhythm Society consensus statement and the Canadian Cardiovascular Society position statement on POTS.
Ready to start?
Book online in a few minutes. No referral needed. We see children, teens, and young adults up to age 30 in Greenville, Charlotte, and by telehealth in SC and NC.