Imagine your body has a gas pedal and a brake system. The gas pedal is your “fight or flight” system: your sympathetic nervous system. It helps you run, react, and survive danger. The brake system is your parasympathetic nervous system: it calms you down, slows your heart, and helps your body rest and digest.
For people with Hyperadrenergic POTS (a type of Postural Orthostatic Tachycardia Syndrome), the gas pedal is stuck down—and the brakes aren’t working. Even when you’re just standing up or walking slowly, your body acts like it’s running from danger. Heart rate spikes, blood pressure may rise, and you feel jittery, dizzy, and exhausted.
This happens because the parts of your brain and nervous system that are supposed to regulate these signals (like a thermostat) aren’t doing their job correctly.
The complex phenomenon of autonomic hyperactivity—often labeled as paroxysmal sympathetic hyperactivity (PSH) or hyperadrenergic POTS—through the lens of functional neuroanatomy and clinical physiology. While these syndromes have been named and observed for decades, true understanding remains limited when we fail to consider the full structure and function of the central nervous system.
What we often see in the clinic—orthostatic intolerance, lightheadedness, tachycardia, blurred vision, tinnitus, chest pressure, sweating abnormalities, and crushing fatigue—is not just a heart rate problem or an adrenal problem. It’s a neural regulation problem.
We dive deeper into the brain-body feedback systems that keep the autonomic nervous system in balance—and what happens when those systems fail. I walk through three major contributors to sympathetic overactivation:
1. Normal compensation in response to stress,
2. Broken feedback loops due to missing inhibition, and
3. Loss of descending control from the brain to the brainstem and spinal cord.
We dive into the roles of specific regions like the rostroventrolateral medulla (RVLM), paraventricular nucleus (PVN), and hypothalamus, outlining how injuries or dysfunction—whether structural, inflammatory, ischemic, or chemical—can “take the brakes off” the sympathetic system and leave patients in a state of perpetual fight-or-flight.
Most importantly, I discuss why targeting symptoms alone—like using beta blockers for tachycardia—often fails. If the problem originates in the brainstem or higher cortical centers, those interventions miss the mark. This video is about finding the root cause, not managing noise downstream.
If you or your patient is struggling with unexplained sympathetic symptoms, persistent fatigue, or multisystem dysregulation despite conventional treatment, this video offers a deeper framework for identifying where the dysfunction truly begins—and what to do about it.
📍 The Keiser Clinic in Chelsea, Michigan
People travel from across the country and around the world to seek care at the Keiser Clinic, where we approach complex autonomic conditions at the source, rather than masking symptoms. We Typically see new patients within 4–6 weeks. When you’re suffering, you deserve better than to be on a year-long wait list.
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🏆 Patient success stories
• Patrick's Recovery Story
• Recovering From POTS
🔹 Our Pledge to You:
Empathy & Compassion
We have spent over a decade walking this path with people like you. We come each day ready to listen and provide the best possible care.
Partnership = Results
We aim to empower our patients and know those that invest in their own healing usually see the best results.
No False Hopes
We promise to be honest, straightforward, and respectful of your time. No fluff. Just real expectations and real solutions.
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Our treatments are tailored to your nervous system — the right dose, at the right time, for you. That’s how change happens.
00:00 – When the Brakes Fail: Understanding Autonomic Hyperactivity
01:10 – Orthostatic Intolerance Symptoms Explained
03:00 – Why the Sympathetic System Gets Stuck On
05:13 – Three Reasons Fight or Flight Won’t Turn Off
06:42 – Mapping Dysfunction Across the Neuraxis
09:22 – How the Hypothalamus and RVLM Drive Overactivation
11:25 – Brain Injuries, Blood Flow, and Autonomic Dysfunction
13:34 – The Brainstem’s Role in Autonomic Reflexes
15:09 – What Causes Hyperadrenergic POTS
17:20 – Why Beta Blockers May Miss the Root Cause
18:39 – What Autonomic Hyperactivity Looks Like in the Body
19:13 – Parasympathetic Symptoms and Overlap Cases
20:17 – Bradycardia, Hypotension, and Cerebral Perfusion Drops
21:15 – Can You Have Parasympathetic and Sympathetic Overactivity?
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