Conditions
The autonomic nervous system runs what happens automatically: heart rate, blood pressure, digestion, temperature, and circulation. When it misfires, symptoms can feel scattered and unrelated, such as lightheadedness, a racing heart, exhaustion, brain fog, and poor exercise tolerance. This page explains dysautonomia and its related conditions, including POTS, and how we approach them at Strong Tower.
If you faint, have chest pain, or have trouble breathing, or if symptoms are sudden or severe, call 911 or go to the nearest emergency department. A medical provider should evaluate new or unexplained racing heart, fainting, or chest pain.
Cleveland Clinic describes dysautonomia as a general term for disorders that disrupt the autonomic nervous system. Symptoms range from mild to severe and can include dizziness or fainting on standing, a fast or slow heart rate, fatigue, brain fog, headaches, sleep problems, digestive issues, sweating changes, and temperature swings. Diagnosis can be difficult, uses tools such as a tilt table test and other heart and blood tests, and Cleveland Clinic suggests seeking a provider with dysautonomia experience if needed. It says there is no cure, but many symptoms can be managed (Cleveland Clinic, September 2023).
We take a functional neurology approach to look at how your autonomic nervous system is working, as a complement to your medical care. The conditions below are the ones we group under this heading.
POTS is a condition in which standing up causes an exaggerated rise in heart rate without a matching drop in blood pressure. A 2019 review in the Cleveland Clinic Journal of Medicine describes the usual criteria: a heart rate increase of at least 30 beats per minute within 10 minutes of standing (at least 40 for people under 19), sustained for more than 30 seconds, without a significant blood pressure drop, with symptoms present for at least 6 months (Cleveland Clinic Journal of Medicine, May 2019).
Common symptoms include lightheadedness, a racing or pounding heart, fatigue, and brain fog. Digestive symptoms such as abdominal pain, heartburn, or bowel changes are also common. Dehydration, heat, alcohol, exercise, and menstruation can make symptoms worse. The same review calls POTS a multifactorial syndrome rather than a single disease, and notes that no medication is approved by the FDA specifically for it. Management usually starts with non-drug steps such as education, gradual exercise, compression garments, and more fluid and salt, with medications added if needed. Do not change your fluid, salt, or medicine without talking to your doctor.
As part of your evaluation we can look at how your heart rate and circulation respond when you change position.
Orthostatic intolerance is a broad term for symptoms that appear when you are upright and ease when you sit or lie down, such as dizziness, weakness, a racing heart, and a grey-out of vision. It is a pattern, not a single disease, and POTS is one form of it. Symptoms can be worse in the morning, after meals, in heat, or after standing for a long time. We can look at how your body responds to position changes as part of your evaluation, alongside your medical care.
Vasovagal syncope is the common faint: a sudden, brief loss of consciousness set off by standing too long, strong emotion, pain, or the sight of blood. It happens when a reflex briefly drops heart rate and blood pressure, which cuts blood flow to the brain. Warning signs can include lightheadedness, nausea, warmth, and greying or tunneling of vision. Anyone who faints for the first time, or faints without a clear trigger, should be seen by a medical provider.
Autonomic dysregulation is a general imbalance between the two branches of the autonomic nervous system: the sympathetic "fight or flight" side and the parasympathetic "rest and digest" side. People may describe feeling wired but tired, with a resting heart rate that stays high or swings, unrefreshing sleep, digestive upset, temperature swings, and a constant sense of being on edge. Many things can affect autonomic function, including stress, sleep, illness, and injury, and we look at what may be contributing.
Gastroparesis is slow emptying of the stomach. Symptoms include bloating, nausea, early fullness, and sometimes vomiting of undigested food. It needs a medical diagnosis, because stomach emptying is checked with tests and other conditions have similar symptoms. The vagus nerve helps drive the stomach's muscle activity, and we can look at how it is working as part of the gut-brain picture, alongside your medical care. You can read more on our Gut-Brain Connection page and our Vagus Nerve page.
Thermoregulatory dysfunction means the body has trouble holding its temperature steady. People may notice cold or discolored hands and feet, sudden flushing, night sweats, or poor tolerance of heat or cold. Changes like these have many possible causes, so they are worth raising with your doctor. We look at what may be contributing, alongside your doctor's evaluation.
Dr. Wright is a Doctor of Chiropractic with advanced training in functional neurology. Autonomic conditions are usually diagnosed and managed by medical providers, and we see our care as complementary to that care. Your evaluation looks at how your nervous system is working, as described on our Neurological Exam & Evaluation page.
Dysautonomia is the general term for autonomic nervous system disorders. POTS is one specific form of it, defined by a rise in heart rate on standing.
A medical provider diagnoses it, usually by measuring heart rate and blood pressure lying down and standing. Other causes of a fast heart rate need to be ruled out first.
There is no cure for dysautonomia, according to Cleveland Clinic, but many symptoms can be managed. Talk with your medical provider about what to expect in your case.
Fatigue is a major complaint in POTS, and brain fog is common. The reasons are not fully understood. See our Brain Fog & Cognition page.
Researchers are still learning about what can bring POTS on. Ask your medical provider about your own history.
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Next steps
Symptoms that feel scattered often have a pattern.