POTS (Postural Orthostatic Tachycardia Syndrome)
When the heart races on standing up
Quick Facts
- Full name: Postural orthostatic tachycardia syndrome
- Type: Autonomic nervous system disorder
- Hallmark: Heart rate jumps on standing
- Most affected: Young women
Overview
POTS stands for postural orthostatic tachycardia syndrome, a disorder of the autonomic nervous system that controls automatic functions such as heart rate and blood pressure. In POTS, standing up triggers an abnormally large rise in heart rate, often 30 beats per minute or more, producing symptoms like dizziness, palpitations, and fatigue.
The condition most often affects young women and can begin after a viral illness, surgery, pregnancy, or a period of prolonged bed rest. Although POTS can be disabling and is sometimes mistaken for anxiety, it is a genuine physical condition. With lifestyle measures and, when needed, medication, many people improve over time.
Symptoms
Symptoms usually appear or worsen on standing and ease when lying down.
- Dizziness or lightheadedness when standing
- A racing or pounding heartbeat
- Fatigue, sometimes severe
- Brain fog and difficulty concentrating
- Headaches, shakiness, sweating, or nausea
- Fainting or near-fainting in some people
- Worsening symptoms in heat, after meals, or when dehydrated
Symptoms can change from day to day and may significantly affect work, school, and daily life.
Causes
POTS is a syndrome with more than one possible underlying cause, and often no single cause is found.
- Blood pooling on standing: Blood collects in the legs and abdomen, so the heart speeds up to compensate.
- Autonomic nerve dysfunction: Faulty control of blood vessels and heart rate.
- Triggers: A viral infection, surgery, pregnancy, or long bed rest can precede onset.
- Related conditions: POTS can occur with connective tissue or autoimmune conditions.
Risk Factors
- Being a young woman, often between the teens and thirties
- A recent viral illness or other acute illness
- Prolonged bed rest or physical deconditioning
- Pregnancy or recent surgery
- Joint hypermobility or connective tissue conditions
- A family history of similar symptoms
Diagnosis
Diagnosis centers on showing an abnormal heart-rate rise on standing while excluding other causes.
- Standing or tilt-table test: Heart rate and blood pressure are recorded lying down and after standing, looking for a sustained, excessive rise in heart rate without a major blood pressure drop.
- Heart tests: An ECG and sometimes monitoring to check the heart rhythm.
- Blood tests: To rule out anemia, thyroid problems, and other conditions with similar symptoms.
Treatment
Treatment combines lifestyle measures with medication when needed.
- Fluids and salt: Drinking plenty of water and, if advised, increasing salt to expand blood volume.
- Exercise reconditioning: A gradual program, often beginning with recumbent exercise, helps many people.
- Compression garments: Worn on the legs and abdomen to limit blood pooling.
- Trigger management: Avoiding overheating, prolonged standing, and large carbohydrate meals.
- Medications: Several types can help control heart rate or support blood pressure when lifestyle steps are not enough.
Management is usually long-term, and consistency with exercise and hydration tends to bring the most improvement.
Prevention
POTS itself cannot usually be prevented, but symptoms can often be reduced:
- Stay well hydrated throughout the day
- Increase salt only if your doctor recommends it
- Stand up slowly and avoid standing still for long periods
- Stay active to avoid deconditioning
- Avoid getting overheated
- Eat smaller, more frequent meals if large meals trigger symptoms
When to See a Doctor
See a doctor if you regularly feel dizzy or have a racing heartbeat on standing, especially when it interferes with daily life. Evaluation can both consider POTS and rule out other causes of the symptoms.
Seek prompt care for fainting that causes injury, chest pain, severe or worsening shortness of breath, or palpitations along with feeling that you might pass out, as these need urgent assessment to confirm the heart and circulation are working safely.
Frequently Asked Questions
What does POTS stand for?
POTS stands for postural orthostatic tachycardia syndrome. It describes an abnormally large rise in heart rate that happens when a person stands up, leading to dizziness, palpitations, and fatigue.
Is POTS a heart disease?
Not exactly. POTS is a disorder of the autonomic nervous system, which controls heart rate and blood pressure, rather than a problem with the heart muscle or valves. The heart races because of faulty regulation of circulation on standing.
Can POTS improve over time?
Yes. Many people improve with consistent management, including a gradual exercise program, increased fluids and salt, compression garments, and sometimes medication. Recovery often takes time and ongoing effort.
Why do fluids and salt help POTS?
They increase 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, since extra salt is not safe for everyone.
When should I get urgent care?
Seek urgent care for fainting that causes injury, chest pain, severe shortness of breath, or palpitations with the feeling you might pass out. These symptoms need prompt assessment to ensure 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.