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  • Writer's pictureSarah Schafer, MD

PART 1: Is it POTS? Mimics

Updated: Aug 14, 2023

This page is Part 1 of a 4-part series.

Part 1: Is it POTS? Mimics

Do you feel lightheaded, shaky, or like your heart is pounding when you stand for more than a few minutes?

This could be postural orthostatic tachycardia syndrome (POTS), a disorder of the autonomic nervous system. Or it could be something else. Your clinician needs to consider a variety of causes for your symptoms so that you get proper diagnosis and treatment.

How do I get diagnosed?

Your PCP primary care provider (PCP) is often a good place to start. Even if they are not familiar with autonomic disorders (dysautonomia), they are usually familiar with other conditions that can mimic POTS. Because few clinicians (including some neurologists) are trained to diagnose autonomic disorders, I recommend that you share reference materials with them, as explained in Parts 2-4 of this blog post series and on the POTS page. Be prepared to have your symptoms downplayed or psychologized. If your clinician defaults to explanations such as deconditioning, anxiety, or “functional neurological disorder” rather than performing a thorough evaluation, it is usually best to find another clinician.

POTS is a physiological condition, not caused by psychological disorders. It is often debilitating. Diagnosis and treatment can greatly improve quality of life.

Keep scrolling for the list of mimics...

POTS mimics (excluding other autonomic disorders, See Part 2)
  • Medication/ herb/ supplement side effects

  • Recreational drugs

  • Heart conditions: including heart rhythm disorders (especially inappropriate sinus tachycardia), mitral valve prolapse, and others

  • Lung disease, especially pulmonary hypertension

  • Brain disorders such as stroke or epilepsy

  • Anemia

  • Adrenal insufficiency

  • Pheochromocytoma (a rare endocrine tumor)

  • Carcinoid tumor

  • Graves’ disease

  • Amyloidosis, especially early may cause POTS symptoms

  • Paraneoplastic syndromes

  • Eating disorders, starvation, or severe malabsorption

  • Physical deconditioning after prolonged bed rest (this is not just a person who does not exercise)

  • Anxiety and/ or panic attacks. Anxiety should never be the default explanation; a thorough evaluation of medical causes is essential.

Orthostatic hypotension (OH) is easy to mistake for POTS. Learn more in Part 2 and Part 3.

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