Vascular Disease and POTS

How Vascular Disease Can Cause POTS Symptoms

Postural Orthostatic Tachycardia Syndrome (POTS) is often linked to nervous system dysfunction, but vascular issues can be a major underlying cause that is frequently overlooked. Pelvic venous disease, vein compressions, and venous insufficiency can significantly impact blood flow, leading to POTS-like symptoms.

How Poor Circulation Contributes to POTS

When veins in the pelvis or abdomen are compressed or weakened, blood does not return efficiently to the heart. This can lead to:

  • Blood pooling in the lower body – reducing circulation to the brain and causing dizziness or fainting when standing.

  • Increased heart rate – as the body compensates for poor blood return.

  • Autonomic dysfunction – triggering symptoms such as fatigue, exercise intolerance, and brain fog.

  • Chronic inflammation – which may worsen symptoms of POTS and other dysautonomia-related conditions.

Why This is Often Missed or Misdiagnosed

Many patients with POTS are initially evaluated by cardiologists, neurologists, or OB-GYNs, who often do not specialize in vascular conditions. Because of this:

  • Traditional tests like tilt table tests and echocardiograms may not reveal the underlying vascular issue.

  • Initial tests can miss key compressions unless contrast-enhanced imaging is used.

  • Pelvic congestion, May-Thurner, or Nutcracker Syndrome may go undiagnosed without proper testing. And can continue to get worse.

Proper Testing is Essential

To detect vascular-related POTS, imaging tests such as CT venography, venograms, and intravascular ultrasound (IVUS) are needed. Contrast is essential to properly visualize vein compressions and reflux.

If you experience POTS symptoms that do not improve with standard treatments, consider getting evaluated for vascular conditions by a vascular specialist or interventional radiologist. Identifying and treating underlying venous issues can significantly improve symptoms and quality of life.

Take Control of Your Health

✅ If you have POTS, advocate for a vascular evaluation.

✅ Ensure your scans are reviewed by a vascular specialist.

✅ Know that vascular-related POTS is real and treatable with proper diagnosis.