Blog

Uncategorized

Primary vs. Secondary POTS: A Neurological Perspective from a Functional Neurology Clinic in Carmel, Indiana

January 24, 2026

Primary vs. Secondary POTS: A Neurological Perspective from a Functional Neurology Clinic in Carmel, Indiana

Postural Orthostatic Tachycardia Syndrome (POTS) is often described as a heart-rate condition. Many patients in Carmel, Indiana and the greater Hamilton County area are told their symptoms are “cardiac,” “anxiety-related,” or simply unexplained.

But clinically, POTS is not just a heart issue.

POTS is a disorder of autonomic nervous system regulation (the system that controls the heart’s rate and rhythm). Understanding how that dysfunction developed is critical to choosing the right evaluation and care approach.

At our functional neurology clinic in Carmel, IN, we explain POTS using two primary pathways:
Primary POTS and Secondary POTS.

This distinction is often missed — and it’s one of the biggest reasons patients struggle to get answers.

What Is POTS From a Neurological Standpoint?

The autonomic nervous system (ANS) is the part of the nervous system that regulates automatic functions such as:

  • Heart rate
  • Blood pressure
  • Blood vessel constriction and dilation
  • Cerebral (brain) blood flow
  • Postural and positional control

When you move from sitting or lying down to standing, the autonomic nervous system should rapidly adapt in order to get blood to the brain and not have it pool in the legs from gravity. In POTS, that regulation fails, resulting in an exaggerated heart-rate response and symptoms such as:

  • Dizziness or lightheadedness
  • Fatigue or exercise intolerance
  • Brain fog
  • Palpitations
  • Nausea or visual disturbances

Importantly, POTS is not a single disease. It is a pattern of dysautonomia, and patterns require deeper neurological context.

Primary POTS: When the Nervous System Is the Primary Issue

Primary POTS occurs when the autonomic nervous system itself is the main source of dysfunction.

In these cases:

  • No clearly identifiable disease explains the autonomic failure
  • Standard cardiac tests and blood work are often normal
  • The nervous system struggles to regulate heart rate and vascular tone appropriately
  • Genetic, developmental, past concussions or subtle neurological factors may contribute

For patients with Primary POTS, the autonomic nervous system is the diagnosis — not a downstream effect of another illness.

At a functional neurology level, care focuses on improving nervous system regulation, neurological integration, and adaptive capacity rather than simply suppressing symptoms.

Secondary POTS: When Autonomic Dysfunction Is a Downstream Effect

Secondary POTS develops when another condition disrupts autonomic signaling.

This is extremely common in patients who seek care for POTS in Indiana after a major health event.

In Secondary POTS:

  • An upstream condition stresses or injures the nervous system
  • Autonomic dysfunction develops as a secondary consequence
  • Symptoms may appear suddenly or progressively after a trigger

Common contributors include:

  • Inflammatory or autoimmune processes
  • Post-viral or post-infectious syndromes
  • Peripheral or small fiber neuropathy
  • Connective tissue disorders
  • Metabolic or mitochondrial dysfunction

In these cases, treating POTS alone is rarely sufficient. Progress depends on identifying and addressing both the autonomic dysfunction and the underlying driver.

Why the Difference Between Primary and Secondary POTS Matters

Many patients that we have seen in Carmel and surrounding Indiana communities are frustrated because their care focuses only on symptom control.

Understanding whether POTS is primary or secondary helps explain:

  • Why symptoms may have started suddenly after illness, stress, or injury
  • Why medications alone may not resolve the problem
  • Why two patients with the same diagnosis can require very different care plans

From a functional neurology perspective, evaluation must match the neurological pattern, not just the diagnosis label.

POTS Is a Pattern — Not a One-Size-Fits-All Diagnosis

When POTS is treated as a single condition, care becomes generic.
When it is recognized as a pattern of autonomic dysregulation, deeper answers become possible.

Similar symptoms can arise from:

  • Different neurological drivers
  • Different regulatory failures
  • Different recovery timelines

This is why comprehensive neurological assessment is essential for patients with persistent or complex POTS symptoms.

A Functional Neurology Approach to POTS in Carmel, Indiana

At our clinic in Carmel, IN, we focus on understanding how the nervous system is functioning — not just what symptoms are present.

By identifying whether POTS follows a primary or secondary neurological pathway, care can be more precise, targeted, and effective.

Key Takeaways

  • Primary POTS originates within the autonomic nervous system itself
  • Secondary POTS reflects autonomic dysfunction driven by another condition
  • Both are real
  • Both are complex
  • Both require thoughtful neurological evaluation

If you are searching for answers to POTS or dysautonomia in Carmel, Indiana, and have been told your tests are “normal” despite ongoing symptoms, the nervous system may be where the real answers live.

Understanding the pattern is the first step toward meaningful progress.