When a pattern gets overlooked
Jordan feels lightheaded while waiting in line and notices that sitting changes how they feel. A coworker wonders whether it is stress.
Patient guide
When should I get help?
A fast or pounding heart, dizziness, and feeling very tired can each have several causes. A doctor can help find out what is happening, even if you already have POTS.
Call 911 for emergency help
Call 911 in the U.S. or your local emergency number if you have chest pain, trouble breathing, or pass out with a racing or pounding heart. Call right away if someone passes out and does not wake up quickly. Follow the dispatcher’s directions.
MedlinePlus emergency signsCall your doctor’s office today
Call if you pass out and recover, or if your heart starts racing or pounding in a new or different way. Tell the office what happened and ask how soon you should be seen. Use emergency help if you have any of the signs above.
MedlinePlus guidance on a racing or pounding heartMake a doctor’s appointment
Make an appointment if you often feel dizzy, very tired, or feel your heart race when you stand. Tell your doctor if sitting or lying down helps, or if the symptoms get in the way of school, work, or daily tasks.
Johns Hopkins Medicine overview of POTSWhat to tell your doctor
- What you felt and when it started.
- What you were doing and whether you were standing, sitting, or lying down.
- How long it lasted, what helped, and how often it happens.
- Any medicines or supplements you take and how the symptoms affect your day.
May 2025 manuscript
Read the full publication
The Role of Stress, Inflammation, and Depression in Postural Orthostatic Tachycardia: A Psychoneuroimmunology Perspective by Tawana McCou, MS.
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Chapter 1
POTS and daily life
Postural orthostatic tachycardia syndrome (a condition that can make your heart beat much faster when you stand) (POTS) is a chronic (long-lasting) disorder involving autonomic regulation (how your body controls jobs like your heartbeat on its own). People may experience a marked rise in heart rate and symptoms such as lightheadedness or palpitations (feeling your heart race, pound, or flutter) when upright. Fatigue (feeling very tired) and difficulty concentrating can affect work, school, and social life. Clinicians evaluate the overall pattern and consider other possible explanations. Clinical sources
Reflection. Think about a task that involves standing, such as waiting in line. What could someone miss about the experience if they only saw the person for a few minutes while seated?
Chapter 2
What psychoneuroimmunology (the study of how your mind, nerves, and body’s germ-fighting system work together) asks
Psychoneuroimmunology (the study of how your mind, nerves, and body’s germ-fighting system work together) (PNI) studies relationships among psychological processes, the nervous system, and immune function (how your body fights germs). McCou uses it as a lens for exploring how these processes may interact in POTS.
Stress and mood
Unpredictable symptoms can complicate plans and create emotional strain. The review considers how that strain may relate to coping and quality of life (how well you feel and manage daily life).Autonomic regulation (how your body controls jobs like your heartbeat on its own)
The autonomic nervous system (the nerves that run body jobs you do without thinking, like your heartbeat) helps regulate functions such as heart rate. In POTS, symptoms during upright activity can constrain daily routines.Immune function (how your body fights germs)
The review considers inflammation (the body’s response to injury or illness, which can cause swelling) and immune dysregulation (when the body’s germ-fighting system does not work as expected) as possible contributors. The role of these mechanisms may vary across people and remains a research question.Chapter 3
Separate observations from explanations
The manuscript is a narrative literature review (a paper that brings together ideas and findings from other studies). It brings together findings across several topics and proposes ways to interpret their relationships. When studies report that two factors occur together, ask how each was measured, which occurred first, and what other explanations the study considered.
Try it. A study finds higher distress among participants who report more disruption to daily activities. List two plausible explanations and one piece of evidence that might help distinguish them.
Chapter 4
Make room for physical and emotional needs
The review discusses cognitive behavioral therapy (talk therapy that helps you practice new ways to think and act), mindfulness-based stress reduction (a program that uses quiet practice to pay attention and handle stress), and biofeedback (practice using a device to see and learn about body signals like your heartbeat) as possible supports for coping and quality of life (how well you feel and manage daily life). In a coordinated care discussion, a person can raise concerns about physical symptoms, emotional strain, and barriers to daily activities. Each concern deserves attention on its own terms.
Discussion prompt. How could a care team explain the purpose of a behavioral health referral in a way that acknowledges the patient’s physical symptoms and priorities?
Chapter 5
Practice with everyday scenarios
These fictional cases are for education and discussion.
The cost of unpredictable symptoms
Amira has diagnosed POTS. She has begun turning down invitations because she cannot predict how long she will be able to stay, and she misses seeing friends.
A claim about inflammation (the body’s response to injury or illness, which can cause swelling)
A headline says a study found an association between an inflammatory marker (a clue found in a body sample that may point to inflammation) and symptom severity in a small POTS sample.
Chapter 6
Prepare for a discussion
Use this worksheet for a class discussion or to organize questions for a healthcare visit. Use hypothetical or de-identified notes. Entries save in this browser when storage is available.
About the manuscript
McCou, T. (2025, May 2). The Role of Stress, Inflammation, and Depression in Postural Orthostatic Tachycardia: A Psychoneuroimmunology Perspective [Narrative literature review]. Walden University, School of Health Sciences.
Clinical background
- Johns Hopkins Medicine overview of POTS
- Raj, Fedorowski, and Sheldon (2022), Diagnosis and management of POTS
Educational companion. Discuss individual diagnosis and care with a qualified clinician. Cover image is an AI-generated illustration.