What Causes POTS? Common Triggers and Risk Factors

If you've ever stood up and felt your heart pound, your vision blur, or the room start to spin, you know how disruptive that moment can be. For people living with postural orthostatic tachycardia syndrome, or POTS, this isn't an occasional inconvenience. It's a daily reality that can make standing in line, climbing stairs, or even getting out of bed feel like a challenge. Understanding what causes POTS is often the first step toward finding real answers, and it's a question many patients ask after months or years of being told their symptoms are "just anxiety" or "just stress."

At Inland Northwest Neurological Performance, we work with patients throughout the Inland Northwest who are dealing with unexplained dizziness, lightheadedness, and autonomic dysfunction. Many of them eventually learn that what looks like a balance problem is actually rooted in how the nervous system regulates blood flow and heart rate. Let's look at the most common triggers and risk factors behind POTS, and what they mean for your path forward.

What Is POTS, Exactly?

POTS is a form of dysautonomia, a broad term for conditions where the autonomic nervous system doesn't function the way it should. The autonomic nervous system handles the things you don't consciously think about: heart rate, blood pressure, digestion, and how your blood vessels constrict when you change position.

In a healthy system, standing up triggers a quick, automatic adjustment that keeps blood flowing to your brain. With POTS, that adjustment misfires. Blood pools in the lower body, the heart compensates by beating faster (often 30 beats per minute or more above your resting rate within ten minutes of standing), and the result is dizziness, brain fog, fatigue, and sometimes fainting.

Common Triggers and Risk Factors

Viral Infections and Post-Viral Onset

One of the most well-documented triggers for POTS is a viral illness. Mononucleosis, the flu, and more recently COVID-19 have all been linked to new-onset POTS symptoms. Researchers believe the virus may trigger an autoimmune response or disrupt the nervous system's regulation of blood vessels and heart rate during recovery. This is why so many long COVID patients report POTS-like symptoms months after their initial infection cleared.

Puberty and Hormonal Shifts

POTS disproportionately affects adolescent girls and young women, and many cases first appear during puberty. Rapid hormonal changes during this period seem to interact with the autonomic nervous system in ways researchers are still working to fully understand. Pregnancy and postpartum hormonal shifts can also trigger or worsen symptoms in some patients.

Autoimmune and Genetic Factors

A growing body of research points to autoimmune activity as a contributing factor in many POTS cases. Some patients test positive for antibodies that interfere with receptors involved in blood pressure regulation. There also appears to be a genetic component, since POTS often runs in families, though no single gene has been identified as the cause.

Connective Tissue Disorders

POTS shows up frequently alongside Ehlers-Danlos syndrome (EDS) and other connective tissue disorders. The theory here involves blood vessel elasticity. If connective tissue is looser than normal, blood vessels may not constrict efficiently when you stand, contributing to the blood pooling that drives POTS symptoms.

Physical Trauma, Surgery, or Prolonged Bed Rest

Any event that disrupts the body's normal deconditioning threshold can act as a trigger. Major surgery, a significant injury, or extended bed rest can all cause the cardiovascular and nervous systems to become less efficient at regulating blood flow. This is part of why some patients notice their first POTS symptoms after a hospitalization or a period of reduced activity, even if the original illness or injury had nothing to do with the nervous system.

Concussion and Head Injury

This is where POTS and neurological trauma intersect in a way we see often in our practice. A concussion or traumatic brain injury can disrupt the brainstem and autonomic pathways that regulate heart rate and blood pressure. Patients recovering from a head injury sometimes develop POTS-like symptoms that get mistaken for lingering post-concussive dizziness, when the underlying issue is actually autonomic dysfunction that needs to be addressed directly.

Why POTS Often Gets Mistaken for Something Else

Because POTS symptoms overlap so heavily with vestibular issues, migraines, and anxiety, it's one of the most commonly misdiagnosed conditions. Patients often describe the same sensations we hear from people dealing with vertigo: a spinning or swaying feeling, unsteadiness, and a fear of standing too quickly in public.

The difference is that POTS originates in the autonomic nervous system's regulation of blood flow, while classic vertigo usually stems from the inner ear or the brain's processing of visual and vestibular signals. Because both conditions involve breakdowns in how the brain, body, and blood vessels communicate, an accurate diagnosis often requires looking at the nervous system as a coordinated whole rather than treating symptoms in isolation.

This is exactly the approach we take with patients experiencing chronic dizziness and imbalance. Many of the people who come through our doors have already tried medications and generic exercises without lasting relief, because those approaches address a single symptom instead of the underlying communication breakdown between the brain and body.

When to Seek Help

If you're experiencing frequent dizziness upon standing, a racing heart, fatigue that doesn't improve with rest, or brain fog that interferes with daily life, it's worth getting a thorough evaluation. A tilt table test or active stand test can help confirm a POTS diagnosis, and ruling out overlapping conditions like vestibular dysfunction is an important part of getting the full picture.

Recovery from POTS and related dysautonomia isn't always a straight line. Some weeks bring noticeable progress, and others bring a step back, and that's a normal part of the process rather than a sign that something has gone wrong. Patients who understand this tend to stay more consistent with their care and see better long-term outcomes.

Finding Answers in Coeur d'Alene

Living with unexplained dizziness, fatigue, or heart palpitations can be isolating, especially when previous providers haven't found an answer. At Inland Northwest Neurological Performance, we take a brain-based, neuroplasticity-driven approach to conditions where the nervous system isn't communicating properly with the rest of the body, including cases where POTS symptoms overlap with vestibular dysfunction.

If you're in the Coeur d'Alene area and searching for answers behind your symptoms, we're here to help you understand what's actually happening and build a path toward real improvement. Schedule a consultation with our team to start getting the clarity you deserve.