Lyme Disease and POTS: Understanding the Overlooked Link Behind Persistent Symptoms

Lyme disease is a condition that requires a proper course of antibiotic therapy for relieving the symptoms. The patient experiences several clinical symptoms, such as fatigue, headache, dizziness, disturbances in sleep, etc.

Some people also experience a rise in heart rate on standing that can have an impact on daily life of an individual. What can be the reason behind the increased heartbeat? Can an increased heartbeat contribute to persistent Lyme disease? In this blog, we will explore the reason behind the persistent clinical symptoms of Lyme disease. 

What is Postural Orthostatic Tachycardia Syndrome (POTS)?

POTS is considered as a major complication of Lyme disease. In POTS, heart rate of the individual rises without a fall in blood pressure. The clinical symptoms of POTS include:

• Lightheadedness
• Brain fog
• Fatigue
• Muscle pain

It was determined that POTS affects between 50000-3 million people in the US.

Risk factors of POTS:

• Female predominance
• Borrelia burgdorferi infection
• Genetic susceptibility
• Hypermobility

What is the link between Lyme disease and POTS?

Persistent Lyme disease can contribute to chronic symptoms, referred to as post-treatment Lyme disease syndrome (PTLDS). Both POTS and Lyme disease share similiar clinical symptoms, particularly those affecting the nervous systema. Overlapping clinical symptoms include:

• Gastrointestinal symptoms
• Palpitations
• Dizziness
• Trouble with memory and concentration

In the later stages of the infection, autonomic nervous system will be affected that triggers POTS. There will be dysregulation of the immune system in both Lyme disease and POTS. Lyme disease can cause inflammation, resulting in POTS. The autonomic nervous system will be affected when the symptoms are persistent for a long period.

How is POTS diagnosed in Lyme disease patients?

POTS is often not diagnosed in individuals with Lyme disease, due to the overlapping of clinical symptoms. The doctor will take a complete medical history of the patient and evaluate the health status of the individual.

A 10 minute stand test is conducted where the heart rate and blood pressure of the patient are recorded. If the heart rate is more than 30 beats/min, the diagnosis of POTS is confirmed. In the Tilt table test, heart rate and blood pressure are monitored when the patient is lying down or in an upright position.

What are the treatment strategies for managing POTS and Lyme disease?

Postural Orthostatic Tachycardia Syndrome and Lyme disease are two conditions that need a complex and individualized management strategy due to the overlapping clinical symptoms that make it more difficult to treat each of them. The initial action is to adequately treat the latent Lyme infection.

Early Lyme disease is usually treated successfully using oral drugs like doxycycline, amoxicillin, or cefuroxime. Intravenous antibiotics are needed in the later stages of infection.

Management of POTS:

• Increased fluid and salt intake to raise the blood volume
• Compression garments can help in enhancing the blood flow
• Dietary changes, focusing on low-carbohydrate diet
• Regular exercises and physical therapy can improve the heart health
• Medicines can be taken, such as beta blockers, fludrocortisone, etc can be used for regulating the heart rate and lowering the blood pressure.

Since both Lyme disease and POTS may lead to fatigue-related symptoms, cognitive problems, pain, and anxiety, it is essential to manage the similar symptoms. Autonomic dysfunction is a complex condition that requires a multidisciplinary team of neurologists and specialists in the field of autonomic disorders to efficiently cope with such an association and enhance the patient outcomes.

What is the role of immune dysregulation in the development of POTS after Lyme disease?

Immune dysregulation plays an important role in the emergence of postural orthostatic tachycardia syndrome after Lyme disease. Lyme disease can cause the dysregulation of the autonomic nervous system, which is one of the major contributors to POTS.

The inflammation from Lyme disease can damage the nerve fibers, resulting in small fiber neuropathy. This condition is commonly found in POTS patients. Inflammatory cytokines elevation and persistent immune system imbalance may also enhance impairment of vascular and neurologic activity, which aggravates the symptoms of POTS.

Researchers also indicate that autoantibodies, which are proteins of the immune system attacking the own body receptors in the autonomic control, can be found in some POTS patients. Such autoantibodies can disrupt important signals that are used to maintain the vascular tone and heart rate, which also contributes to orthostatic intolerance.

Conclusion:

• The link between Lyme disease and POTS is considered as a major contributor to persistent symptoms in many patients.
• It is important to understand the overlapping of clinical symptoms for proper diagnosis and treatment.
• Hence, the treatment requires a dual approach that involves managing the symptoms of Lyme disease and dysfunction of the autonomic nervous system.

References:

1. Johns Hopkins Lyme Disease Research Center. Could POTS be the hidden cause of your persistent Lyme disease symptoms? [Internet]. Baltimore (MD): Johns Hopkins University School of Medicine; 2025 May 9 [cited 2025 Jun 24]. Available from:https://www.hopkinslyme.org/lyme-education/what-is-dysautonomia/

1. Project Lyme. Exploring the Overlap Between Dysautonomia and Lyme Disease. [Internet]. 2025 Jan 13 [cited 2025 Jun 24]. Available from:https://projectlyme.org/exploring-the-overlap-between-dysautonomia-and-lyme-disease/
2. Tafler L, Chaudry A, Cho H, Garcia A. Management of post-viral Postural Orthostatic Tachycardia Syndrome with craniosacral therapy: A case report. Cureus. 2023 Feb 15;15(2):e35009. PMID: 36938206; PMCID: PMC10021347. [cited 2025 Jun 24]. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021347/