Why Does Sjögren's Cause Dizziness & a Racing Heart?

Yes, it is common to experience dizziness and a racing heart when you have Sjögren’s syndrome. While Sjögren’s is best known for causing dry eyes and a dry mouth, it is a systemic condition that can affect your entire body ^[1]. For many patients, these cardiovascular symptoms are caused by dysautonomia—a dysfunction of the autonomic nervous system ^[2].

If your heart races specifically when you stand up, you may be experiencing a specific type of dysautonomia known as POTS (Postural Orthostatic Tachycardia Syndrome) ^[3].

The Autonomic Nervous System and Sjögren’s

Your autonomic nervous system operates in the background, automatically controlling vital bodily functions such as your heart rate, blood pressure, sweating, and digestion ^[2]. When you have Sjögren’s syndrome, your immune system can mistakenly attack and damage the small nerve fibers that regulate this system, a condition called small fiber neuropathy (SFN) ^[4][5].

Research also shows that specific autoantibodies produced in Sjögren’s syndrome (such as anti-M3R and anti-gAChR) can directly interfere with nerve receptors, disrupting the signals between your brain and your body ^[6][7].

Symptoms of Dysautonomia and POTS

When the autonomic nervous system struggles to communicate properly, it can lead to a wide range of debilitating symptoms.

• Orthostatic Intolerance and POTS: You may feel dizzy, lightheaded, or like you might faint when transitioning from lying down to standing ^[8]. In POTS, the body struggles to adjust blood pressure upon standing, causing the heart to beat excessively fast (tachycardia) to compensate ^[9]. Safety tip: If you feel faint, sit or lie down immediately—preferably with your feet elevated—to prevent falls and help blood return to your head.
• Heart Palpitations: You might notice sudden fluttering, pounding, or irregular heartbeats even when you aren’t moving ^[10].
• Digestion Issues: Dysautonomia frequently impacts the gastrointestinal tract. This can cause severe bloating, nausea, or gastroparesis—a condition where the stomach empties food too slowly ^[8][11].
• Profound Fatigue: The constant strain on your nervous and cardiovascular systems to regulate your body can contribute significantly to the deep, heavy fatigue often reported by Sjögren’s patients ^[2].

Managing Symptoms While You Wait

Getting an appointment with an autonomic specialist can take time. While you wait, basic POTS lifestyle interventions may provide some relief. (Always check with your current doctor before making major changes, especially if you have high blood pressure or kidney issues.)

• Hydration and Electrolytes: Many POTS patients benefit from significantly increasing their daily fluid and salt intake to help boost blood volume.
• Compression Garments: Wearing medical-grade compression stockings or abdominal binders can help prevent blood from pooling in your legs and stomach.
• Medication Review: Certain medications, including some blood pressure drugs or antidepressants, can worsen orthostatic intolerance. Ask your pharmacist or doctor for a review.
• Pacing Postural Changes: Take your time when getting out of bed or standing up from a chair.

Next Steps: Building Your Care Team

Because rheumatologists do not always specialize in neurological or cardiovascular issues, treating dysautonomia requires a collaborative approach ^[12]. You will likely need a referral to a neurologist who specializes in autonomic disorders, or a cardiologist, to get properly tested and treated. While evidence-based guidelines for Sjögren’s dysautonomia are still evolving, targeted therapies and medications do exist to help manage these symptoms once you are properly evaluated ^[13][14].

Your specialists may recommend objective testing, such as a tilt-table test, to safely measure your heart rate and blood pressure responses when changing positions ^[15]. Additionally, a skin punch biopsy might be used to confirm if small fiber neuropathy is the underlying cause of your autonomic dysfunction ^[16][17].

Because dysautonomia can severely impact your daily functioning, do not hesitate to strongly advocate for yourself ^[18]. If your current doctor dismisses your cardiovascular symptoms, clearly state how they impact your daily life and directly request a referral for an autonomic evaluation.