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Is it POTS or Anxiety?

This presentation explores the overlap between Postural Orthostatic Tachycardia Syndrome (POTS) and Anxiety. Learn about sympathetic upregulation and the fight or flight response.

Overview of POTS and Anxiety

POTS is a condition characterized by an abnormal increase in heart rate upon standing, while anxiety is a mental health disorder causing excessive worry and fear. Let’s delve into the connections between these two distinct yet interrelated conditions.

Sympathetic Upregulation

Sympathetic upregulation refers to the increased activity and arousal of the sympathetic nervous system, responsible for the body’s “fight or flight” response. Our bodies have a “window of tolerance” and outside this region to high is considered hyperarousal. A decrease of this window is hypoarousal.


Hyperarousal can be caused by trauma, stress, medical or mental health conditions.

  • Anxiety
  • Restlessness
  • Irirtability
  • Rapid Heart Rate / Chest Pain
  • Nervousness
  • Anger
  • Headaches / Nausea / Change in appetite
  • Shortness of breath


Hypoarpusal is too little of energy. Lack of an activated nervous system. Difficulty in finding motivation. This can cause us to be parasympathetically dominant.

  • Fatigue / Sleepy
  • Low blood pressure
  • Depression / Decreased mood
  • Concentration difficulty
  • Brain fog / Confused
  • Depersonalization
Distinguishing Between POTS and Anxiety

Understanding the Fight or Flight Response

The fight or flight response is our body’s natural reaction to perceived threats or stressors. Finding the balance of the fight or flight response is to find homeostasis. Homeostasis is the balance of our autonomic system. Fight or flight is the adrenal response to stress or events which result in the activation of the sympathoadrenal system and hypothalamic pituitary adrenocortical (HPA-Axis). When the amygdala believes to be in a threat state it we redirect the hypothalamus to start the production of extra cortisol and adrenalin.

Vital Scan, State of Art Diagnostic testing

EKG, Blood Pressure Arms and Legs, Pulse/Oxygen finger and toes, total report for autonomic function. Call 610-544-9800 to schedule an evaluation at Hope Brain Center for Autonomic Nervous System Testing

Distinguishing Between POTS and Anxiety

Distinguishing Between POTS and Anxiety

While POTS and Anxiety share similar symptoms such as palpitations and dizziness, understanding their distinct features is crucial. POTS is often misdiagnosed because of its similarities to having anxiety attacks. The rapid heart rate, lack of breath ect. Heart rate in POTS patients show to rise and drop drastically. Even in the simplest of movement like standing from a sitting position. This is a factor that separates Tachycardia from Anxiety attacks. The rapid increase to decrease of heart rate. It is not just an increase, it is scattered EKG readings. Causing dizziness, fatigue, tire, and even fainting. Patients struggle to deal with temperature regulation and hot showers or hotter weather can cause symptoms to worsen.

Different Forms of POTS?


  • Decreased sympathetic innervation
  • Pooling of blood
  • Discoloration of extremities when standing or when warm
  • Loss of sweat to extremities


  • Increased levels of our stress hormone Norepinephrine
  • Rises in systolic blood pressure when standing up
  • Extreme Tachycardia / Heart Palpitations
  • Nausea / Vomiting
  • Migraines / Headaches


  • Low blood volume in plasma and red blood cells
  • Decreased exercise tolerance
  • Weakness

Symptoms and Diagnostic Criteria for Anxiety

1. Excessive Worry

Constant or irrational concerns about various aspects of life, often accompanied by restlessness.

2. Panic Attacks

Episodes characterized by intense fear or discomfort along with physical symptoms like sweating and shortness of breath.

3. Sleep Disturbances
Trouble falling asleep, staying asleep, or experiencing restless sleep due to racing thoughts and anxiety.
4. Cognitive Distortions
Biased thought patterns that contribute to an exaggerated perception of potential dangers and negative outcomes.

Treatment Approaches for POTS and Anxiety

  1. Lifestyle Modifications
  2. Exercise with Oxygen
  3. Upper Cervical Chiropractic
  4. Harmonic vibration
  5. Gyrostim
  6. Erchonia Lasers
  7. Functional Medicine testing
  8. Neurofeedback


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