16560 Postural Orthostatic Tachycardia Syndrome Pots

Overview

Postural Orthostatic Tachycardia Syndrome, usually called POTS, is a condition where your heart beats much faster than normal when you stand up. This can make you feel dizzy, tired, or like you might faint. It is a type of dysautonomia, meaning the part of your nervous system that controls automatic things like heart rate and blood pressure does not respond smoothly to changes in posture.

POTS is not rare. Studies suggest it affects millions of people around the world, though many doctors have only recently learned to recognize it. Because symptoms can overlap with other conditions, it may be underdiagnosed.

POTS most often affects women between the ages of 15 and 50, but it can also occur in men, children, and older adults. It sometimes appears after a viral illness, surgery, pregnancy, or another major stress on the body.

Symptoms

Common symptoms

• Dizziness or lightheadedness when standing
• Heart palpitations (feeling your heart pound, skip, or race)
• Fatigue or extreme tiredness
• Brain fog (trouble concentrating or remembering)
• Nausea or stomach upset
• Headaches
• Feeling like you might faint, or actually fainting

Symptoms in children

• Similar symptoms to adults, like dizziness and fatigue
• Stomach aches or frequent nausea
• Trouble standing in line or at school assemblies
• Unusually tired after normal activities

Symptoms in older adults

• More falls or feeling unsteady when standing
• Lightheadedness with walking or changing position
• Fatigue that may be mistaken for aging
• Less noticeable racing heart, but still present

Causes

Main causes

• The exact cause is unknown, but POTS often begins after a viral infection, pregnancy, surgery, or head injury.
• It may involve problems with how nerves control blood vessel squeezing, or with the amount of blood in the body.
• It can also be linked to other health conditions, such as autoimmune diseases or joint hypermobility.

Risk factors

• Female sex
• Age between 15 and 50
• A recent infection or illness
• A history of autoimmune disease
• Family history of POTS or nervous system disorders

When to see a doctor

See a doctor urgently if:

• Call your local emergency number if you faint and hurt yourself, have chest pain, or have trouble breathing.
• If you feel so dizzy you cannot safely stand or walk, seek urgent medical advice.

Book a routine appointment if:

• Make an appointment with your doctor if you regularly feel dizzy, lightheaded, or notice your heart racing when you stand up.
• If these symptoms are interfering with school, work, or daily activities, bring them up with a healthcare provider.

Diagnosis

A doctor usually diagnoses POTS by measuring your heart rate and blood pressure while you lie down, sit, and then stand. Diagnosis is based on a specific heart rate increase when standing, together with symptoms. The doctor will also make sure other heart or nerve conditions are not causing the problem.

Tests that may be done

• Active stand test (heart rate and blood pressure are checked while changing position)
• Tilt table test (you lie on a table that slowly tilts upward, under medical supervision)
• Blood tests to check for anemia, thyroid problems, or other causes
• Electrocardiogram (ECG) to check the heart's rhythm

What to expect at your appointment

The diagnosis process is usually painless and can often be done in an office visit. You may be asked to drink extra water beforehand and avoid caffeine or heavy meals. Wear comfortable clothes. The appointment may take about an hour. The doctor will explain your results and review next steps with you.

Treatment

Treatment for POTS is tailored to each person. It usually focuses on improving symptoms, staying hydrated, and gently building activity tolerance. Some people also need medication to help manage their heart rate or blood pressure, but the first steps are often lifestyle changes.

Self-care at home

• Drink plenty of fluids throughout the day (ask your doctor what a good target is for you).
• Add extra salt to your meals, unless you have high blood pressure or kidney disease.
• Wear compression stockings that reach at least to the waist or thighs to help blood return to the heart.
• Raise the head of your bed by a few inches to help your body adjust to gravity.
• Avoid standing still for long periods; if you must stand, move your legs, tense your calf muscles, or cross your legs.
• When you feel faint, sit down and put your head between your knees, or lie down with your legs up.

Medical treatments

Your doctor may suggest prescription medicines to help control heart rate, blood pressure, or fluid balance. There are several classes of medication that can be tried, but the right choice depends on your specific symptoms, other health conditions, and how you respond. No single drug works for everyone, and any medicine should be started and adjusted under a doctor's guidance.

When is surgery considered?

Surgery is not a standard treatment for POTS. In very rare cases, an underlying health problem requiring surgery may be found, but this is not common. Your healthcare team will talk with you about all options if surgery is ever considered.

Living with this condition

Living with POTS means learning to pace yourself and listen to your body. Some days will be better than others. Plan your activities around your energy levels, take rest breaks, and don't be afraid to ask for help. Small changes, like sitting down in the shower or when brushing your teeth, can make a big difference.

Lifestyle tips

• Try to keep a regular sleep schedule and avoid late nights.
• Break exercise into short, frequent sessions rather than one long workout.
• Use cooling towels or a fan if heat makes symptoms worse.
• Keep a symptom diary to notice patterns and triggers.
• Ask trusted friends or family to help when you have a bad day.

Diet and exercise

Eat small, regular meals to avoid large shifts in digestion and blood flow. Include salt only if your doctor recommends it. For exercise, start with recumbent activities — those done lying or seated, like a stationary bike, rowing machine, or swimming. Build up slowly over time. A physical therapist can design a safe plan for you.

Mental health and emotional wellbeing

Living with a chronic condition can be emotionally draining. You may feel anxious, frustrated, or down. These feelings are normal. Talk to someone you trust, and consider speaking with a mental health professional if you need extra support. If you are ever in crisis, reach out to a crisis helpline in your area.

Prevention

There is no known way to prevent POTS. You can reduce the impact of symptoms by staying well-hydrated, avoiding sudden position changes, and keeping as active as possible within your limits.

Vaccines

There is no evidence that vaccines cause POTS. Staying up to date with recommended vaccinations is important because infections can sometimes trigger or worsen symptoms. Talk to your pharmacist or doctor about which vaccines are right for you.

Screening programmes

There is no routine screening test for POTS. It is usually diagnosed after symptoms appear and other conditions have been ruled out.

Complications

If left untreated

• Falls and injuries, such as concussions or fractures, from fainting or losing balance
• Difficulty keeping up with work, school, or family life
• Ongoing fatigue and brain fog that can affect mood and relationships

Long-term outlook

Although POTS can be challenging, it is not life-threatening. Many people improve significantly with the right treatment and lifestyle changes. Some recover fully over time, while others learn to manage symptoms successfully. Most people find a way to live a full and meaningful life.

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