Postural Orthostatic Tachycardia Syndrome (POTS)
An abnormal heart-rate rise on standing up
Quick Facts
- Type: Autonomic nervous system disorder
- Hallmark: Heart rate jumps on standing
- Most affected: Young women
- Management: Fluids, salt, exercise, sometimes medicine
Overview
Postural orthostatic tachycardia syndrome (POTS) is a disorder of the autonomic nervous system, which controls automatic body functions such as heart rate and blood pressure. In POTS, standing up causes the heart rate to rise much more than normal, often by 30 beats per minute or more, leading to symptoms such as dizziness, palpitations, and fatigue.
POTS most commonly affects young women, often beginning in the teens or twenties. The condition can be debilitating and is sometimes mistaken for anxiety, but it is a real physical problem with the body's regulation of circulation. Many people improve with a combination of lifestyle measures and, when needed, medication.
Symptoms
Symptoms typically appear or worsen when standing and improve when lying down.
- Lightheadedness or dizziness on standing
- A racing or pounding heartbeat (palpitations)
- Fatigue, sometimes severe
- Brain fog, trouble concentrating, or headaches
- Shakiness, sweating, or nausea
- Fainting or near-fainting in some people
- Exercise intolerance and worsening with heat, meals, or dehydration
Symptoms can vary from day to day and may significantly affect school, work, and daily activities.
Causes
POTS is not a single disease but a syndrome with several possible underlying mechanisms. In many people, the exact cause is not identified.
- Reduced blood return on standing: Blood pools in the legs and abdomen, prompting the heart to beat faster to compensate.
- Autonomic nerve dysfunction: Faulty signaling in the nerves controlling blood vessels.
- Triggers: Symptoms sometimes begin after a viral illness, surgery, pregnancy, or a period of prolonged bed rest.
- Associated conditions: POTS can occur alongside conditions affecting connective tissue or other autoimmune and chronic illnesses.
Risk Factors
- Being a young woman, particularly between the teens and thirties
- A recent viral infection or other illness
- Prolonged bed rest or deconditioning
- Pregnancy or recent surgery
- Conditions affecting connective tissue, such as joint hypermobility
- A family history of similar symptoms
Diagnosis
Diagnosis focuses on documenting an abnormal heart-rate rise on standing and ruling out other causes.
- Standing or tilt-table test: Heart rate and blood pressure are measured while lying down and after standing, looking for a sustained, excessive rise in heart rate without a large drop in blood pressure.
- Heart evaluation: An ECG and sometimes heart monitoring to check the rhythm.
- Blood tests: To look for anemia, thyroid problems, and other conditions that can cause similar symptoms.
Because symptoms overlap with other conditions, diagnosis can take time and may involve several specialists.
Treatment
Treatment is tailored to the individual and usually combines lifestyle measures with medication when needed.
- Increased fluids and salt: Drinking plenty of water and, if advised, increasing salt intake to expand blood volume.
- Exercise and reconditioning: A gradual, structured program, often starting with recumbent exercise, helps many people over time.
- Compression garments: Worn on the legs and abdomen to reduce blood pooling.
- Avoiding triggers: Managing heat, standing for long periods, and large carbohydrate meals.
- Medications: Several types may be used to control heart rate or support blood pressure when lifestyle steps are not enough.
Care is usually long-term, and many people see meaningful improvement, especially with consistent exercise and fluid management.
Prevention
POTS cannot generally be prevented, but flares and symptoms can often be reduced:
- Stay well hydrated throughout the day
- Increase salt intake if your doctor recommends it
- Stand up slowly and avoid standing still for long periods
- Stay as active as possible to avoid deconditioning
- Manage heat exposure and avoid getting overheated
- Eat smaller, more frequent meals if large meals worsen symptoms
When to See a Doctor
See a doctor if you regularly feel dizzy, lightheaded, or have a racing heartbeat when standing, especially if it interferes with daily life. These symptoms deserve evaluation, both to consider POTS and to rule out other causes.
Seek prompt medical attention for fainting that causes injury, chest pain, severe or worsening shortness of breath, or palpitations with feeling like you may pass out, as these may need urgent assessment to make sure the heart and circulation are working safely.
Frequently Asked Questions
What exactly happens in POTS?
When a person with POTS stands up, their heart rate rises abnormally, often by 30 beats per minute or more, without the expected blood pressure control. This leads to symptoms like dizziness, palpitations, and fatigue that improve on lying down.
Is POTS just anxiety?
No. Although POTS can cause a racing heart and shakiness that resemble anxiety, it is a genuine physical disorder of the autonomic nervous system. It is diagnosed by documenting an abnormal heart-rate rise on standing, not by mood.
Can POTS get better?
Many people improve over time, especially with consistent management. A gradual exercise program, increased fluids and salt, compression garments, and sometimes medication can substantially reduce symptoms, though it often requires long-term effort.
Why are fluids and salt recommended?
Increasing fluids and salt helps expand blood volume, which reduces the blood pooling and rapid heart rate that occur on standing. Salt should only be increased on a doctor's advice, as it is not safe for everyone.
When should POTS symptoms prompt urgent care?
Seek prompt care for fainting that causes injury, chest pain, severe shortness of breath, or palpitations that come with feeling you may pass out. These need urgent assessment to make sure the heart is working safely.
References
- National Institute of Neurological Disorders and Stroke (NINDS). Postural Tachycardia Syndrome.
- Dysautonomia International. Postural Orthostatic Tachycardia Syndrome.
- MedlinePlus, U.S. National Library of Medicine. Autonomic nervous system disorders.