If you’ve been diagnosed with Postural Orthostatic Tachycardia Syndrome (POTS) and find that your treatment plan looks very different from someone else with the same condition, you’re not alone—and there’s a good reason why. POTS is not a one-size-fits-all disorder. It has subtypes, each with different underlying mechanisms, symptoms, and treatment responses.
Understanding your POTS subtype can be a game-changer in tailoring an effective treatment strategy. In this article, we’ll break down the most recognized POTS subtypes, how they differ, and what it means for your care.
What Is POTS, in Simple Terms?
POTS is a form of dysautonomia, or dysfunction of the autonomic nervous system. It’s primarily defined by a sustained heart rate increase of 30+ beats per minute (or 40+ in teens) within 10 minutes of standing, without a significant drop in blood pressure. But the condition affects more than just heart rate. Many patients experience:
- Dizziness or lightheadedness
- Brain fog
- Palpitations
- Nausea
- Chronic fatigue
- Shakiness
- Exercise intolerance
What makes treatment tricky is that POTS can be caused by different physiological imbalances, which is why identifying your subtype is so important.
Why Subtypes Matter for Treatment
Not every POTS patient needs the same medications, diet, or physical therapy approach. What helps one person can make another feel worse. That’s because the root causes vary, and so do the treatment priorities.
Identifying your subtype allows your POTS specialist MD to develop a more precise and effective plan—whether you’re in early diagnosis or still trying to stabilize symptoms. Some subtypes respond best to increased salt and fluids. Others may require medications to balance adrenaline levels or treat autoimmune activity.
The 4 Most Common POTS Subtypes
1. Neuropathic POTS
Cause: Damage or dysfunction in the small fiber nerves, especially those that control blood vessel constriction in the lower body.
Symptoms:
- Blood pooling in legs and feet
- Purple discoloration of limbs when standing
- Weakness, tingling, or burning sensations
Treatment Focus:
- Compression garments to help blood return to the heart
- Exercise therapy focusing on leg muscles
- Fludrocortisone to increase blood volume
- Salt and fluid loading
Neuropathic POTS is more common in patients with small fiber neuropathy or autoimmune disorders. A POTS specialist in MD may run skin biopsies or autonomic nerve testing to confirm this subtype.
2. Hyperadrenergic POTS
Cause: Overactivity of the sympathetic nervous system, leading to excess norepinephrine levels when upright.
Symptoms:
- Significant increases in blood pressure and heart rate upon standing
- Sweating
- Anxiety-like symptoms
- Tremors
- Headaches
Treatment Focus:
- Beta blockers (e.g., propranolol) to slow heart rate
- Clonidine or methyldopa to reduce adrenaline surges
- Avoid stimulants, including caffeine
- Monitor for Mast Cell Activation Syndrome (MCAS)
Hyperadrenergic POTS can be especially challenging because symptoms overlap with anxiety. However, measuring plasma norepinephrine levels while standing (above 600 pg/mL) helps confirm the diagnosis.
3. Hypovolemic POTS
Cause: Low blood volume (hypovolemia) due to impaired blood regulation, poor fluid retention, or hormonal dysfunction.
Symptoms:
- Constant thirst
- Low blood pressure
- Fatigue and exercise intolerance
- Dizziness when dehydrated
Treatment Focus:
- Aggressive fluid and sodium intake (2–3 liters of water, 3–10g of salt daily)
- Fludrocortisone or desmopressin for volume expansion
- Electrolyte monitoring
- Diet rich in potassium and magnesium
This subtype can mimic the others, but lab tests showing low renin and aldosterone levels help narrow it down. Patients often benefit from a hydration protocol supervised by a POTS doctor in Maryland MD or similar regional specialists.
4. Secondary POTS
Cause: Develops as a result of another condition like:
- Ehlers-Danlos Syndrome (EDS)
- Autoimmune diseases (e.g., lupus, Sjögren’s)
- Lyme disease
- Long COVID
Symptoms: Varies depending on the underlying condition, but usually includes a mix of fatigue, gastrointestinal symptoms, dizziness, and joint pain.
Treatment Focus:
- Addressing the underlying illness
- Coordinated care between multiple specialties
- Gentle physical therapy
- MCAS management when present
If your postural orthostatic tachycardic syndrome MD evaluation reveals an underlying trigger, it’s essential to treat both the POTS symptoms and the root disease.
Diagnosing Your POTS Subtype
A POTS doctor accepting new patients in MD or any other specialized clinic will usually conduct several tests, such as:
- Tilt Table Test (to confirm diagnosis)
- Blood volume studies
- Standing norepinephrine test
- Skin biopsy (for neuropathy)
- Blood pressure variability and autonomic testing
Make sure your provider is experienced in autonomic disorders and familiar with differentiating between POTS subtypes.
Why It’s Easy to Get Misdiagnosed
Because symptoms overlap across subtypes—and with conditions like anxiety or chronic fatigue syndrome—it’s easy for patients to be misdiagnosed or undertreated. Many individuals see 5+ doctors before getting a correct diagnosis.
That’s why it’s crucial to:
- Track your symptoms with a daily log
- Monitor your heart rate when standing
- Document symptom triggers
- Work with a POTS clinic MD familiar with personalized protocols
Why Treatments May Differ From Patient to Patient
Here’s a comparison of how treatments vary:
| Subtype | Main Focus | Typical Medications | Helpful Therapies |
|---|---|---|---|
| Neuropathic | Improve blood flow and nerve function | Fludrocortisone, Midodrine | Compression, resistance training |
| Hyperadrenergic | Lower adrenaline & heart rate | Beta blockers, Clonidine | Mindfulness, low-stim diet |
| Hypovolemic | Increase blood volume | Fludrocortisone, Salt tablets | Hydration protocol, electrolyte support |
| Secondary | Treat root illness + stabilize ANS | Varies | Multi-specialty care, pacing |
Mental Health and POTS Subtypes
It’s also worth noting that certain subtypes, especially hyperadrenergic POTS, can mimic anxiety disorders. Patients are sometimes prescribed medications that may worsen symptoms if the root issue isn’t addressed.
A knowledgeable POTS doctor MD will distinguish between the physiological and psychological elements and ensure you receive proper care—sometimes coordinating with neuropsych or behavioral specialists if needed.
Next Steps: How to Get the Right Care
If you suspect your POTS symptoms aren’t being properly managed—or if your treatments aren’t working—it may be time to ask your provider:
- Have we identified my POTS subtype?
- Are we treating the root cause, not just the symptoms?
- Should we adjust medications based on my response?
- Would I benefit from a referral to a POTS specialist MD?
And if you’re in Maryland or surrounding areas, consider consulting a POTS doctor accepting new patients MD who can help guide your personalized care plan based on subtype-specific protocols.
Final Thoughts
Understanding the subtype of POTS you have is not just a technical detail—it’s a crucial step toward better symptom control, quality of life, and long-term stability. While all POTS patients experience orthostatic intolerance, the path to managing it effectively is not universal.
Whether you’re just starting your diagnostic journey or looking to fine-tune your treatment, knowing your POTS subtype puts the power back in your hands.
Need help finding a provider who understands the nuances of POTS? Reach out to clinics experienced in postural orthostatic tachycardic syndrome MD, or search for a POTS doctor in Maryland MD accepting new patients, and ask about their experience with subtype-specific care.
Let your treatment work for you, not just your diagnosis.
