POTS Part 4 Symptoms

Dr Graham Exelby March 2025

Introduction

Postural Orthostatic Tachycardia Syndrome (POTS) can be conceptualized as a disorder of autonomic instability with substantial pathophysiological overlap with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME), Long COVID, Fibromyalgia, Gulf War Syndrome and other post-viral syndromes.

While POTS is often distinguished by its hallmark orthostatic intolerance and cardiovascular dysregulation, its broader symptomatology—severe fatigue, cognitive dysfunction (“brain fog”), and post-exertional malaise (PEM)—mirrors that of CFS/ME.

The mechanistic underpinnings of POTS appear multifactorial, involving metabolic dysfunction, preload failure, intracranial hypertension (ICH), and progressive brainstem hypoperfusion, all of which converge to impair autonomic regulation. Brainstem dysfunction, in particular, is emerging as a central unifying factor in POTS, given its role in coordinating baroreflex function, cerebral autoregulation, and immune signalling.