Periaqueductal Gray-vagus Nerve Interface Malfunction Explain the Natural History With Its Numerous Co-morbidities?

Inclusion Criteria: * Females 12-21 years old * Able to communicate and provide consent/assent * English speaking * Diagnosed with POTS (POTS will be defined standardly as a symptomatic ≥ 40 bpm rise in heart rate without a drop in blood pressure and with symptoms of orthostatic intolerance clinically) * Age-matched healthy control subjects: no POTS or other neurological disorders Exclusion Criteria: * Inflammatory arthritis, connective tissue or auto-immune disorder * Any chronic neurological disorder besides POTS * Evidence of unstable medical disorder, such as kidney (rising creatinine, or end-stage renal failure) or liver impairment (rising AST or ALT, or end-stage with coagulopathy), poorly controlled significant cardiovascular (CHF), respiratory, endocrine (diabetes - A1c \> 9 - or untreated thyroid dysfunction) or uncontrolled psychiatric illness (such as untreated depression, psychosis, etc.) * Neuropathy, central nervous system disorder (e.g., Cerebral palsy, developmental delay, seizure disorder, MS, stroke, etc.) * Treatment with a drug or medical device within the previous 30 days that has not received regulatory approval * Use of hormones (except insulin, thyroid replacement or oral contraceptives, which will be carefully documented) * Current substance or alcohol abuse * Any major surgical intervention with general anesthesia in the last 60 days and minor procedure, such as tooth extraction, endoscopy, etc., with local or conscious sedation within 7 days * An…