What Actually Causes POTS? A Mechanistic Reading of Postural Orthostatic Tachycardia Syndrome — Frequently asked questions about POTS

How do I know which pathway my POTS is on? The recognition patterns above are the starting point. Post-viral onset suggests Pathway 1. Concurrent gut symptoms and low heart rate variability suggest Pathway 2. Hypermobility, family history of similar features, and the broader hEDS-POTS-MCAS triad suggest Pathway 3. Onset after prolonged inactivity or bed rest suggests Pathway 4. Most cases have features of more than one pathway, and identifying the dominant pathway is a clinical task that benefits from structured case review. Is the four-pathway framework recognized by mainstream cardiology and autonomic medicine? Not in this specific form. The literature recognizes that POTS is heterogeneous and that subtypes exist (hyperadrenergic, hypovolemic, neuropathic, and so on). The literature does not consistently stratify the cases into the mechanistically distinct upstream pathways described here. The framework synthesizes findings from cardiovascular autonomic neurology, gut-brain axis research, connective tissue genetics, and post-viral mitochondrial biology into a clinical stratification that is being developed and tested through case experience. Can POTS be cured? Cure is not a useful framing for most cases. Substantial improvement is realistic for most cases with the right mechanistic stratification and the right sequenced intervention. Some Pathway 1 cases recover to near-basel