Postural Orthostatic Tachycardia Syndrome (POTS)
Postural orthostatic tachycardia syndrome, or POTS, is a problem with the autonomic nervous system. This system controls body functions you do not have to think about, such as heart rate, blood pressure, sweating, and digestion. POTS causes symptoms when you sit up or stand. Your heart rate rises more than it should. POTS may begin after a viral illness, surgery, pregnancy, or an injury. It may also start without a clear cause.
What Does POTS Mean?
Postural: Related to the position of your body
Orthostatic: Related to standing upright
Tachycardia: A heart rate that is faster than expected
Syndrome: A group of symptoms that happen together
What is Happening in My Body?
When you stand, gravity causes some blood to move into your legs and abdomen. Normally, your blood vessels tighten and your heart rate rises slightly to keep blood flowing back to your heart and brain. With POTS, this adjustment does not work as well. Blood may collect in the lower body, or there may not be enough blood returning to the heart. The heart then beats faster to help keep blood moving. The reason this happens can differ from person to person.
Because of this, you may have:
- Dizziness or lightheadedness
- Near fainting or fainting
- A fast or pounding heartbeat
- Fatigue
- Brain fog, or trouble thinking clearly
- Shortness of breath
- Headaches
- Nausea
- Shaking or sweating
- Blurred vision
- Poor balance
- Trouble with exercise
- Nervous or anxious
Symptoms often improve when you lie down.
It is important to know:
- Your symptoms are real and physical. POTS is not caused by anxiety.
- Symptoms may change from day to day.
- Heat, long periods of standing, illness, dehydration, large meals, and menstrual periods may make symptoms worse.
- POTS can affect anyone, but it is more common in girls and women, teens, and young adults.
- Treatment can help you manage symptoms and return to more daily activities
How is Postural Orthostatic Tachycardia Syndrome (POTS) Diagnosed?
A trained provider will review your symptoms, health history, and medicines. They will measure your heart rate and blood pressure while you are lying down and standing. This may be done with a 10-minute standing test or a tilt table test.
For a POTS diagnosis:
- Your symptoms get worse when you are upright and often improve when you lie down.
- Your heart rate stays at least 30 beats per minute higher within 10 minutes of standing. For teens ages 12 to 19, the increase is at least 40 beats per minute.
- Your blood pressure does not have a large drop during the first few minutes of standing.
- Your symptoms have lasted at least three months.
- Another problem, such as dehydration, blood loss, anemia, fever, a thyroid problem, or a medicine side effect, does not better explain your symptoms.
A fast heart rate by itself does not prove that you have POTS.
Other tests may include:
- An electrocardiogram, or ECG, to check your heart rhythm
- Blood tests to look for other causes
- Autonomic tests that check how your heart rate, blood pressure, and breathing work together
- QSART, which checks the nerves that control sweating
- A skin biopsy if your provider suspects damage to small nerves
Not everyone needs all of these tests.
What Your Provider May Ask
Your provider will ask you about your symptoms and experiences as they work to diagnose you. It may be helpful to think about, and even write down, your answers to the questions below
- When do your symptoms start?
- Do they begin when you sit up or stand?
- How long have you had them?
- Do you feel better when you lie down?
- Have you fainted or almost fainted?
- Does your heart race with standing or light activity?
- Did your symptoms start after an illness, surgery, pregnancy, or injury?
- What medicines or supplements do you take?
How is Postural Orthostatic Tachycardia Syndrome (POTS) Treated?
There is no single treatment that works for everyone. Your plan should match your symptoms and health needs. Your provider may suggest one or more of the following options.
Education and Pacing
Learn what makes your symptoms worse. Change positions slowly. Plan rest breaks when needed.
Fluids and Salt
Drinking more fluid and getting more salt may help increase blood volume. Ask your provider before adding salt. Extra salt may not be safe for people with certain heart, kidney, or blood pressure problems.
Compression Clothing
Compression clothing around the belly and legs can help push blood back toward the heart.
Smaller Meals
Large meals can make symptoms worse. Eating smaller meals more often may help.
Exercise or Physical Therapy
A slow, supervised exercise program can improve blood flow and exercise tolerance. Some people start with seated or reclined exercise, such as using a recumbent bike, rowing, or swimming.
Medicine
Some people need medicine to increase blood volume, tighten blood vessels, or slow the heart rate. Examples include fludrocortisone and midodrine. Your provider will choose medicine based on your needs.
What Can I Expect Over Time?
Will I Get Better?
Many people improve with the right treatment, but POTS can last a long time. Symptoms may come and go. There is no set recovery time.
How Long Will It Take?
Finding the right treatment plan may take time. Improvement often happens slowly over several months or longer. Your plan may need to change as your symptoms change.
Can I Do My Usual Activities?
Many people return to school, work, exercise, and other activities. You may need to pace yourself and make changes during times when your symptoms are worse.
When Should I Call My Provider?
Call your provider promptly for:
- New or repeated fainting
- A fall or injury
- Repeated vomiting or trouble keeping fluids down
- Sudden hearing loss
- New trouble walking
- Symptoms that are quickly getting worse
When Should I Get Urgent Medical Care?
Call 911 or go to the emergency room for:
- Severe or new chest pain
- Severe trouble breathing
- New weakness or numbness, especially on one side
- Trouble speaking
- New double vision
- A sudden, severe, or “worst ever” headache
- Fainting with a head injury, seizure, or trouble waking up
Questions to Ask Your Provider
It may be helpful to ask you provider questions like the ones below. This may help you learn more about your symptoms and prepare for any future treatment.
- Do my symptoms fit POTS?
- What tests do I need?
- Should I change how much fluid or salt I get?
- Would compression clothing help me?
- Do I need physical therapy or a supervised exercise plan?
- Could any of my medicines make my symptoms worse?
- Do I need medicine for POTS?
- Are there activities I should limit for now?
Key Points to Remember
- POTS affects the autonomic nervous system.
- It causes symptoms when you sit up or stand.
- Your heart rate rises more than expected without a large early drop in blood pressure.
- Your symptoms are real and are not caused by anxiety.
- Treatment may include fluids, salt, compression clothing, exercise, and medicine.
- Many people improve, but recovery time is different for each person.
Additional Resources
- Cleveland Clinic – POTS: Causes, Symptoms, Diagnosis & Treatment
- Johns Hopkins Medicine – Postural Orthostatic Tachycardia Syndrome (POTS)
- National Institute of Neurological Disorders and Stroke – Postural Tachycardia Syndrome (POTS)