The 3 Types of POTS

It’s common to hear people describe strange symptoms that don’t seem related, such as itchiness, rashes, gut problems, brain fog, poor sleep, blood pressure problems, and even pain that moves around the body. These symptoms may be related to a condition called POTS, which is a type of dysautonomia. In this article, we will explore what POTS is, describe the three types of POTS, and discuss some associated conditions. By understanding these factors, people can better understand their symptoms and seek appropriate treatment.

What is POTS?

At its most basic level, POTS is an irregularity between maintaining blood pressure and heart rate. It’s how your nervous system relates to your heart and vascular system, which delivers blood to all your organs and body parts.

Three Types of POTS:

There are three major types of POTS: autoimmune, neurogenic, and adrenergic.

1. Autoimmune POTS, which makes up about 20% of cases, is the most challenging to address because it involves autoantibodies that react on the nerve endings that affect blood pressure and heart rate regulation.
2. Neuropathic POTS involves a loss of nerve endings in the feet and results in irregular blood pressure, usually causing the feet and hands to turn blue or become discolored. Neuropathic POTS often causes blood pressure drops and resulting increases in heart rate.
3. Adrenergic POTS occurs when spikes in adrenaline, epinephrine, and norepinephrine cause blood pressure to rise, resulting in a fast heart rate and elevated blood pressure.

It is possible for individuals to have all three types of POTS together, which can make diagnosis and treatment challenging. Patients with multiple types of POTs can have a myriad of seemingly unrelated mystery symptoms, including anxiety and panic attacks.

Conditions Associated with POTS

POTS is often associated with four other conditions, which make up the Super syndrome. The first is hypermobility, which we’ve discussed in detail in previous blogs. The second is gastrointestinal issues, which may also be autoimmune-related. The third is Mast Cell Activation Syndrome (MCAS), and the fourth is Ehlers-Danlos Syndrome.

Symptoms can vary based on the level of each condition. Sometimes people with MCAS may have more psychiatric symptoms like panic attacks or symptoms that resemble bipolar disorder. Others who tend to have more gastrointestinal symptoms have a racing heart rate, anxiety, bloating, and gas. Some may experience musculoskeletal pain related to hypermobility.

Treating POTS

A strategy I often use in treating POTS involves identifying and treating the symptoms that are most bothersome to an individual. Understanding which of the associated conditions is affecting them the most can help in creating an effective treatment plan.

A Better Understanding of the Types and Causes of POTS

POTS is a type of dysautonomia that can cause a wide range of symptoms. By understanding the three types of POTS and associated conditions, individuals can better understand their symptoms and seek appropriate treatment.

Next week, in part three of this series, I’ll be talking about diseases associated with POTS. My intention in this series is to bring more clarity to this prevalent “mystery” illness.

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