One of the most common things I hear from patients with POTS is this:
“I was told it was anxiety.”
If you have been searching POTS and anxiety, heart racing anxiety or POTS, or wondering whether your symptoms are panic attacks, you are not alone.
POTS and anxiety can look similar on the surface. Rapid heart rate. Light headedness. Internal shakiness. Shortness of breath. Feeling overwhelmed.
But they are not the same condition.
Understanding the difference matters.
Why POTS Is Often Misdiagnosed as Anxiety
POTS, or Postural Orthostatic Tachycardia Syndrome, is defined by an increase in heart rate of thirty beats per minute or more within ten minutes of standing.
Anxiety does not require posture change.
That distinction is critical.
Many people with POTS notice:
• Heart racing when standing
• Symptoms improving when lying down
• Dizziness triggered by heat or prolonged standing
• Fatigue that feels physical rather than emotional
Because symptoms can include palpitations and shakiness, POTS is frequently misdiagnosed as anxiety.
However, POTS is an autonomic nervous system regulation disorder.
In POTS, the autonomic nervous system struggles to regulate heart rate and vascular tone when you move to an upright position.
Your brain senses reduced circulation and increases heart rate aggressively to maintain blood flow.
The tachycardia is compensatory.
Your nervous system is trying to protect cerebral perfusion.
That rapid heart rate can feel like panic. But the mechanism is different.
In anxiety disorders, heart rate increases because of emotional or cognitive triggers. In POTS, heart rate increases because of orthostatic stress.
Can POTS Cause Anxiety Like Symptoms
Yes.
POTS can produce symptoms that feel like anxiety, including:
• Palpitations
• Internal tremor
• Sweating
• Shortness of breath
• Feeling on edge
When the autonomic nervous system is unstable, sympathetic activation can increase. This can create sensations similar to panic.
The important distinction is this:
In POTS, symptoms are often posture dependent.
If lying down significantly reduces symptoms, autonomic dysfunction should be considered.
Heart Racing: Anxiety or POTS
People frequently search heart racing anxiety or POTS because the sensation can feel identical.
Here is a useful distinction:
In POTS
Heart rate increases when standing
Symptoms improve when lying down
There is measurable orthostatic tachycardia
In anxiety
Heart rate increases in response to stress or thoughts
Posture is less relevant
There is no consistent orthostatic pattern
This does not mean someone cannot have both. Some individuals with POTS also develop secondary anxiety because living with unpredictable symptoms is stressful.
But mislabelling autonomic dysfunction as primary anxiety delays proper understanding.
Why the Confusion Happens
Both anxiety and POTS involve the autonomic nervous system.
The autonomic system regulates:
• Heart rate
• Blood pressure
• Breathing
• Stress responses
When this system is dysregulated, symptoms overlap.
However, in POTS the dysregulation is driven by impaired integration between the brainstem, vestibular system, cerebellum and vascular control mechanisms.
It is a regulation issue, not simply an emotional response.
My Perspective on POTS and Anxiety
When someone consults with me in Melbourne or online for POTS and anxiety symptoms, I look beyond the label.
I assess:
• Orthostatic heart rate response
• Vestibular integration
• Postural reflexes
• Oculomotor coordination
• Autonomic balance
• Sensorimotor processing
The goal is to understand whether symptoms are posture driven and regulation based.
As nervous system coordination improves, many patients report reduced palpitations, improved clarity and greater stability when upright.
When regulation improves, the body no longer needs to overcompensate.
When to Consider POTS Instead of Anxiety
If you experience:
• Heart racing primarily when standing
• Dizziness that improves lying down
• Brain fog when upright
• Fatigue that is posture dependent
It may be worth exploring autonomic dysfunction rather than assuming anxiety is the primary cause.
An active stand test or tilt table test can provide objective data.
POTS Support in Melbourne and Online
If you are searching:
POTS and anxiety Melbourne
POTS misdiagnosed as anxiety
Heart racing anxiety or POTS
Dysautonomia Melbourne
POTS specialist Melbourne
I offer chiropractic neurological consultations:
• Face to face in Melbourne
• Online across Australia
• Online worldwide
If you would like clarity around your symptoms and guidance focused on restoring nervous system regulation,
I invite you to book a consultation.
Your symptoms are not imaginary. They reflect a system that may need structured support.
Frequently Asked Questions
Is POTS just anxiety
No. POTS is defined by measurable orthostatic tachycardia and autonomic dysfunction.
Can anxiety cause POTS
Anxiety does not cause the diagnostic criteria of POTS, though stress can influence autonomic tone.
Can you have both POTS and anxiety
Yes. Living with autonomic instability can increase psychological stress.
How do I know if my heart racing is POTS
If it is consistently triggered by standing and improves when lying down, autonomic testing may be appropriate.
Research Articles
Raj S R. Postural Tachycardia Syndrome. Circulation. 2013;127:2336 to 2342.
Sheldon R S et al. Heart Rhythm Society Expert Consensus Statement on Postural Tachycardia Syndrome. Heart Rhythm. 2015;12:e41 to e63.
Arnold A C et al. Postural Tachycardia Syndrome Mechanisms and Management. Journal of the American College of Cardiology. 2018;72:1883 to 1896.
Vernino S et al. Autonomic Disorders. Continuum. 2020;26:44 to 68.
Freeman R et al. Consensus Statement on the Definition of Orthostatic Hypotension and Related Disorders. Clinical Autonomic Research. 2011;21:69 to 72.
