09/03/2026
**POTS IS MORE THAN A FAST HEART RATE**
One of the most common things I hear from people with POTS is that they've been told their symptoms are anxiety, deconditioning, or that nothing can really be done other than learning to manage them.
I disagree.
POTS—Postural Orthostatic Tachycardia Syndrome—is a very real disorder of autonomic regulation. And one of the most important points I make in this new video is that **the rapid heart rate may not be the primary problem.**
When you stand, gravity pulls blood downward. Your autonomic nervous system should immediately adjust your circulation so enough blood continues reaching your brain.
When that system isn't functioning properly, cerebral blood flow can fall.
The result can be:
• Brain fog
• Fatigue
• Lightheadedness
• Headaches
• Exercise intolerance
• Difficulty concentrating
• Anxiety-like physical sensations
• A powerful need to sit or lie down
Your heart then speeds up in an attempt to compensate.
In POTS, that compensation can dramatically overshoot—sometimes producing heart rates of 130, 140, or 150 beats per minute.
But instead of asking only:
**“How do we slow down the heart?”**
I believe we should also be asking:
**“Why isn't the autonomic nervous system regulating circulation normally, and what may be preventing it from recovering?”**
That's where inflammation becomes especially interesting.
Autonomic dysfunction can develop after physical trauma, severe physiological or emotional stress, infections, surgery, and major inflammatory events. COVID has made the relationship between infection and autonomic dysfunction particularly visible.
The nervous system also possesses much more capacity for repair and reorganization than scientists once believed.
So why do some people recover after an injury while others develop symptoms lasting years?
My clinical framework focuses heavily on persistent systemic inflammation as one factor that may interfere with those normal neurological repair mechanisms.
That's why my approach to POTS goes beyond treating the tachycardia itself.
Depending upon the patient, treatment may include conventional measures to support blood pressure and circulation while also addressing inflammatory sources through strategies involving omega-3 fatty acids, extra-virgin olive oil, intestinal bacterial overgrowth when clinically appropriate, and noninvasive vagus nerve stimulation.
The science surrounding some of these mechanisms is still evolving. But after working with autonomic dysfunction for many years, one message I want patients to understand is this:
**Persistent symptoms do not necessarily mean that the nervous system has permanently lost its ability to recover.**
POTS should not automatically be viewed as a lifetime sentence.
In this video I explain how I think about POTS, why brain blood flow matters, how different types of injury can affect autonomic regulation, why chronic inflammation may interfere with recovery, and why treatment should focus on restoring autonomic stability—not simply chasing the heart rate.
▶️ **Watch: Mechanisms of Autonomic Stability: Understanding POTS and the Path to Recovery**
https://youtu.be/yXomEa_MNMc
If you know someone struggling with POTS, Long COVID, orthostatic intolerance, or unexplained autonomic symptoms, please consider sharing this with them.
— Patrick M. Nemechek, DO
*Educational information only. Individual diagnosis and treatment require appropriate medical evaluation.*
