If you’ve ever stood up and felt your heart race, your head spin, and an overwhelming wave of fatigue wash over you, you’re probably wondering what's wrong and what the cause is. For some people, these symptoms aren't just an occasional dizzy spell—they're an everyday battle.
Postural Orthostatic Tachycardia Syndrome (POTS) is a condition that affects the autonomic nervous system and is characterized by an abnormal increase in heart rate when moving from lying to a standing position. Research shows that up to 80-85% of people with POTS1 are women between the ages of 13-50 years.
POTS can make simple actions like getting out of bed feel like climbing a mountain. But there’s hope. With the right knowledge and care, which we'll cover in detail below, you can find ways to manage this condition and get back to feeling like yourself.
In this article:
- What Is Postural Orthostatic Tachycardia Syndrome (POTS)?
- Postural Orthostatic Tachycardia Syndrome Symptoms
- What Causes POTS?
- How Doctors Diagnose Postural Orthostatic Tachycardia Syndrome
- Is Postural Orthostatic Tachycardia Syndrome Dangerous or Permanent?
- Postural Orthostatic Tachycardia Syndrome Treatment
- Treating Another Type of POTS: Hyperadrenergic POTS
- Final Thoughts on POTS Symptoms and Treatments
What Is Postural Orthostatic Tachycardia Syndrome (POTS)?
POTS is a form of dysautonomia, a disorder of the autonomic nervous system that impacts how the body regulates blood flow and heart rate.
The name “postural orthostatic tachycardia syndrome” is a mouthful, so here's what each of these words means2:
- Postural: The position of the body
- Orthostatic: Related to standing upright
- Tachycardia: A heart rate over 100 beats per minute.
- Syndrome: A group of symptoms that happen together
Postural Orthostatic Tachycardia Syndrome Symptoms
The hallmark symptom of POTS is a significant increase in heart rate, usually by 30 beats per minute3 (BPM) or more within 10 minutes of standing. This rise in heart rate can occur without a substantial drop in blood pressure, which makes it different from other conditions.
POTS can cause a wide range of symptoms, and the severity and combination of symptoms can vary from person to person, sometimes making a diagnosis challenging.
While POTS is mostly associated with changes in heartbeat, it's about so much more than just a fast heart rate. It can show up in your life in many different ways, such as by leaving you feeling weak and winded.
POTS symptoms4 can include:
- Dizziness or feeling faint when standing
- Heart palpitations that make you feel like your heart is pounding out of your chest
- Debilitating fatigue that isn’t relieved by rest
- Brain fog that makes it hard to focus or remember things
- Shortness of breath, especially after standing or walking
- Nausea or stomach upset
- Chest tightness or discomfort
- Sweating more or less than usual
- Occasional fainting (especially when symptoms are severe)
What Causes POTS?
When you stand up, your body is supposed to keep everything in balance by slightly increasing your heart rate and narrowing blood vessels to keep blood flowing where it needs to go. But in people with POTS, this system goes a bit haywire, causing a dramatic increase in heart rate that can leave you feeling lightheaded, exhausted, and out of control.
POTS is more common in women than men. It can affect people of all ages but is most commonly diagnosed5 in women between the ages of 15 and 50.
This condition sometimes develops after:
- Viral infections
- Significant hormonal changes, such as during perimenopause
- Pregnancy
- Trauma
Factors that are thought to be involved in the development of POTS6 include peripheral denervation (nerve damage), poor blood flow in the core and lower body, overactivation of the sympathetic nervous system, and reduced blood volume.
People with diabetes, alcoholism, lupus, and certain health conditions are at increased risk for POTS7. That said, in many cases, the exact cause of POTS is unknown.
While the causes aren't always clear, some situations can make POTS symptoms worse, such as:
- Being hot, such as in a hot bath or shower
- Standing up frequently
- Doing intense or strenuous exercise
- Recovering from being sick or having an infection
- Dealing with ongoing fatigue
- Having your period
How Doctors Diagnose Postural Orthostatic Tachycardia Syndrome
Diagnosing POTS can sometimes feel like piecing together a puzzle. Many patients go through multiple doctors before they get answers—but with the right tests and someone who listens to your symptoms, a diagnosis is absolutely possible.
One of the most common diagnostic tests8 is the tilt table test, where you’re positioned from lying flat to upright while your heart rate and blood pressure are monitored. If your heart rate increases significantly when you’re upright without a big drop in blood pressure, it may point to POTS.
Other helpful diagnostic tools that healthcare providers use to make a diagnosis of POTS can include:
- Active stand test: Similar to the tilt table test but performed while standing without the tilt mechanism.
- Blood tests: To rule out other conditions like anemia or thyroid imbalances.
- Echocardiogram: To check for any structural issues with the heart.
Of course, the goal of a diagnosis isn’t just to put a name to your symptoms but to help you find a path forward.
Is Postural Orthostatic Tachycardia Syndrome Genetic?
You may wonder whether POTS runs in families, or it's mainly caused by other factors.
While there’s no definitive “POTS gene,” research suggests that there may be a genetic predisposition in some cases. POTS often overlaps with other genetic conditions, such as Ehlers-Danlos Syndrome, a connective tissue disorder. If multiple people in your family experience similar symptoms, it may be worth mentioning during your evaluation.
Is Postural Orthostatic Tachycardia Syndrome Dangerous or Permanent?
POTS itself is not typically life-threatening, but it can seriously affect your quality of life. For example, frequent dizziness, fatigue, and fainting episodes can lead to anxiety about everyday activities and even prolonged inactivity. And if you fall due to having POTS, this can potentially cause injuries.
The good news? While POTS can be frustrating and limiting, it’s rarely dangerous in terms of causing permanent damage to your heart or body.
As many as 25% of adults with POTS9 experience trouble working normally and going about their everyday lives due to limitations. With the right care, you can take back control and feel more comfortable in different situations.
Understanding POTS and chronic illness can be overwhelming, but Dr. Brighten and Dr. Brehan Crawford break it all down in this podcast episode, offering practical strategies for symptom relief and recovery.
Is POTS an Autoimmune Disease?
Recent studies suggest that POTS may have an autoimmune component in some patients. Researchers have identified antibodies in certain individuals that seem to target parts of the autonomic nervous system.
While it’s not universally classified as an autoimmune disease, the connection is being explored and could explain why some people develop POTS after infections or other immune-related events.
Does Postural Orthostatic Tachycardia Syndrome Go Away?
POTS can be a temporary condition for some people, especially if it develops after a triggering event like a viral infection or pregnancy.
With time, treatment, and lifestyle adjustments, many patients experience significant improvements. However, for others, POTS may be a chronic condition that requires ongoing management.
Postural Orthostatic Tachycardia Syndrome Treatment
There isn’t a one-size-fits-all treatment for POTS, but with the right approach, symptoms can usually be managed and improved.
Treatment for POTS often involves lifestyle changes, supportive therapies, and sometimes medications. Here's more about these approaches:
Lifestyle Modifications:
- Hydration and electrolytes: Drinking plenty of fluids (such as 64-80 ounces or about 2-2.5 liters a day) and LMNT (like sodium) helps your body maintain adequate blood volume. According to experts, many people who have POTS need up to three times more sodium10 than the standard limit recommended by the US Dietary Guidelines (such as 6,000 mg/day), which is normally 2,300 milligrams a day. Try drinking a glass or two of water with some salt in it before standing up if you've been sitting for a while to help raise your blood pressure.
- Avoiding caffeine and alcohol: Limiting alcohol and stimulants like coffee can help manage symptoms since these can interfere with fluid balance and also tend to worsen feelings of dizziness, jitters, and instability.
- Compression garments: Wearing compression socks or abdominal binders can help support circulation and reduce blood pooling in the legs. These are easy to find online and expensive. You can ask your provider for a recommendation choosing one.
- Slow posture changes: Avoid jumping out of bed or standing up too quickly to prevent sudden heart rate spikes. Take breaks when standing up a lot and try to go slowly.
- Gentle, gradual exercise: Low-impact exercises like recumbent biking, swimming, or yoga can help build cardiovascular strength in your core and legs without putting too much strain on your system. Try to do at least 20 to 30 minutes of exercise most days, but start slowly and avoid anything too strenuous if it worsens your symptoms. It's recommended to work with a professional such as a physical therapist when beginning an exercise routine to make sure it's safe and gradual.
- Elevating your head when sleeping: When lying down to sleep, try elevating the head of the bed up on blocks about 4-6 inches to help improve blood flow.
Medications for Postural Orthostatic Tachycardia Syndrome
While the FDA hasn't approved any medications specifically for POTS, your doctor might recommend certain medications11 to help regulate heart rate and blood pressure, including:
- Beta-blockers: To slow the heart rate and reduce palpitations.
- Fludrocortisone: Helps your body retain sodium and water, boosting blood volume.
- Midodrine: A vasoconstrictor that helps prevent blood from pooling in your lower extremities.
- Ivabradine: Helps lower heart rate without impacting blood pressure.
- SSRIs (Selective Serotonin Reuptake Inhibitors): These can help balance your autonomic nervous system and support mental well-being.
Supportive Therapies
- Physical therapy: Specialized exercise programs12 can gradually improve your ability to stand and move without triggering symptoms.
- Cognitive Behavioral Therapy (CBT): POTS can take a toll on your emotional health, such as by increasing anxiety. Therefore, therapy can help you deal with stress, process anxiety, and learn helpful coping mechanisms.
Treating Another Type of POTS: Hyperadrenergic POTS
There’s also a specific subtype of POTS known as hyperadrenergic POTS, where the body produces excessive amounts of norepinephrine, leading to symptoms like high blood pressure, excessive sweating, and an intense fight-or-flight response.
This form of POTS may require different treatments, such as medications that calm the sympathetic nervous system.
Final Thoughts on POTS Symptoms and Treatments
Living with Postural Orthostatic Tachycardia Syndrome can feel isolating and exhausting, but you don’t have to navigate it alone. If you’ve been struggling with symptoms like a racing heart, dizziness, or brain fog, know that help is available, and healing is possible.
By working with a compassionate healthcare team, implementing supportive habits, and listening to your body, you can find your path toward strength and stability—and regain the parts of life you may feel you’ve lost along the way.
References
- https://www.acc.org/Latest-in-Cardiology/Articles/2016/01/25/14/01/Postural-Tachycardia-Syndrome-POTS-Diagnosis-and-Treatment-Basics-and-New-Developments ↩︎
- https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots ↩︎
- https://www.health.harvard.edu/blog/pots-diagnosing-and-treating-this-dizzying-syndrome-202110062611 ↩︎
- https://www.hopkinsmedicine.org/health/conditions-and-diseases/postural-orthostatic-tachycardia-syndrome-pots ↩︎
- https://www.ninds.nih.gov/health-information/disorders/postural-tachycardia-syndrome-pots ↩︎
- https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots ↩︎
- https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/postural-orthostatic-tachycardia-syndrome-pots.html ↩︎
- https://www.dysautonomiainternational.org/page.php?ID=30 ↩︎
- https://www.dysautonomiainternational.org/page.php?ID=30 ↩︎
- https://www.health.harvard.edu/blog/pots-diagnosing-and-treating-this-dizzying-syndrome-202110062611 ↩︎
- https://www.health.harvard.edu/blog/pots-diagnosing-and-treating-this-dizzying-syndrome-202110062611 ↩︎
- https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/postural-orthostatic-tachycardia-syndrome-pots.html ↩︎