Hit Hard By Pots

Overview

POTS stands for postural orthostatic tachycardia syndrome. 'Postural' means related to posture or standing. 'Orthostatic' means when you stand up. 'Tachycardia' means a fast heart rate. 'Syndrome' means a group of symptoms that happen together. POTS affects the way your body controls heart rate and blood pressure when you change position, especially when you stand. Your heart may speed up more than it should, blood may pool in your legs, and you may feel dizzy, tired, or faint. It is a real condition, not 'all in your head.'

POTS is thought to be fairly common, especially in teenagers and young adults. It is often overlooked because symptoms can look like anxiety, dehydration, or just being unfit.

Symptoms

Common symptoms

• Feeling dizzy or lightheaded when standing up
• A heart rate that rises quickly when you stand
• Heart racing, pounding, or fluttering
• Feeling faint or actually fainting
• Tiredness that is worse than usual and does not get better with rest
• Brain fog, or trouble thinking clearly and concentrating
• Nausea or stomach upset
• Headache
• Feeling very tired or breathless with exercise
• Cold, pale, or purple hands and feet
• Chest discomfort
• Bloating or feeling full quickly

Symptoms in children

• Dizziness or feeling faint when standing
• Tiredness that affects school or play
• Stomach pain or nausea
• Headaches
• A fast heart rate
• Fainting
• Trouble keeping up with sports or exercise
• Sleep problems
• Anxiety or worry about symptoms
• Missing school because of symptoms

Symptoms in older adults

• Falls or a fear of falling
• Dizziness when standing
• Tiredness or low energy
• Confusion or brain fog
• A fast heart rate
• Shortness of breath
• Symptoms after eating or after a hot shower
• Symptoms that overlap with other health conditions

Causes

Main causes

• Problems with the autonomic nervous system. This is the body's automatic control system for heart rate, blood pressure, digestion, and sweating.
• Blood pooling in the legs when you stand, so less blood returns to the heart and brain
• Low blood volume, meaning the body has less fluid in the bloodstream than it needs
• Deconditioning, which means losing fitness after being less active for a while
• Starting after an infection, such as a viral illness
• An autoimmune response, where the body's immune system may play a role
• Genetic factors, since POTS can run in families

Risk factors

• Being female
• Being between 15 and 50 years old
• A recent viral infection
• Pregnancy
• Recent surgery or trauma
• Long periods of bed rest
• Joint hypermobility, where joints move more than usual
• A family history of POTS or other autonomic problems
• An autoimmune condition

When to see a doctor

See a doctor urgently if:

• You faint and injure yourself
• You have chest pain
• You have severe shortness of breath
• You feel confused
• You have weakness or numbness on one side of your body
• You have slurred speech
• You faint again and again
• You cannot keep fluids down
• You have signs of dehydration

Book a routine appointment if:

• You feel dizzy or lightheaded when standing for more than a few days
• Your heart races or pounds when you stand
• Tiredness is affecting school, work, or daily life
• You feel faint or have fainted
• You have brain fog or trouble concentrating
• Exercise makes you feel very tired or unwell
• Symptoms started after an infection, pregnancy, or surgery

Diagnosis

Your doctor will ask about your symptoms, examine you, and check your heart rate and blood pressure while you lie down and then stand up. They may refer you to a specialist, such as a cardiologist or a doctor who treats autonomic problems. Diagnosis can take time because other conditions need to be ruled out first.

Tests that may be done

• Active stand test, where your heart rate and blood pressure are checked while you lie down and stand
• Tilt table test, where you lie on a special bed that tilts you upright while your heart rate and blood pressure are watched
• Electrocardiogram, or ECG, to check the heart's electrical rhythm
• Blood tests
• A 24-hour heart monitor to record your heart rate over a day
• Echocardiogram, which is an ultrasound of the heart
• Urine tests

What to expect at your appointment

You may need more than one appointment. Your doctor may ask you to keep a symptom diary. Bring notes about when symptoms happen, what makes them better or worse, and any medicines or supplements you take. Be honest about how symptoms affect your life. This helps your doctor build the right plan.

Treatment

There is no single cure for POTS, but many things can help. Treatment is tailored to you. The goals are to improve blood flow, steady your heart rate, and help you take part in daily life. A healthcare team may include your family doctor, a specialist, a physiotherapist, and other professionals.

Self-care at home

• Drink enough fluids through the day, unless your doctor tells you to limit them
• Ask your doctor if extra salt is safe for you before adding it to your diet
• Try compression stockings or garments if your doctor suggests them
• Stand up slowly, especially after lying down or sitting for a long time
• Avoid very hot showers or baths if they make symptoms worse
• Eat smaller meals more often if big meals make you feel faint
• Raise the head of your bed if your doctor advises it
• Build activity gently, starting with exercise lying down or seated if needed
• Keep a regular sleep routine
• Avoid long periods of bed rest when you can

Medical treatments

Doctors may suggest medicines to help the body hold onto fluid, raise blood pressure, or slow a fast heart rate. Your doctor will talk with you about the possible benefits and risks. Only a qualified healthcare provider can decide if medicine is right for you. Other treatments may include a guided exercise program, physiotherapy, and help with sleep or anxiety.

When is surgery considered?

Surgery is not used to treat POTS itself. In rare cases, surgery may be needed for another health problem found during your check-up.

Living with this condition

POTS can make ordinary tasks feel harder. Plan your day and pace yourself. Sit down when you can. Put your feet up if you feel faint. Tell teachers, employers, or family members what helps you. A symptom diary can help you spot patterns and triggers.

Lifestyle tips

• Keep a regular sleep and wake time
• Avoid standing still for long periods
• Cross your legs or tense your leg muscles if you start to feel faint
• Wear loose, comfortable clothing
• Avoid very hot places, hot tubs, and long hot showers if they trigger symptoms
• Carry water with you
• Ask for school or workplace adjustments if you need them
• Build activity slowly and steadily

Diet and exercise

Eat regular meals and avoid huge meals if they make you feel faint. Your doctor may advise more fluids and, if safe for you, more salt. Exercise helps many people, but it needs to start gently. A physiotherapist or doctor can suggest a program that begins lying down or seated and slowly adds upright activity. Stop and rest if you feel very dizzy or unwell, and ask for advice.

Mental health and emotional wellbeing

It is common to feel anxious, frustrated, or low when symptoms change your life. This is not a sign of weakness, and it does not mean POTS is 'in your head.' Talk to your doctor if you feel anxious, low, or unable to cope. If you ever feel unsafe or in crisis, contact your local emergency number or a crisis service in your area.

Prevention

POTS cannot always be prevented. You can lower your risk by staying hydrated, avoiding long periods of bed rest when possible, and getting advice if you feel faint after an infection, surgery, or pregnancy. Early help can make symptoms easier to manage.

Vaccines

There is no vaccine for POTS itself. Staying up to date with routine vaccines recommended by your healthcare provider can help prevent some infections that may trigger POTS.

Screening programmes

There is no routine screening test for POTS. If you often feel dizzy or your heart races when you stand, ask your doctor for an assessment.

Complications

If left untreated

• Falls and injuries from fainting
• Deconditioning, or losing fitness from being less active
• Missing school or work
• Anxiety and low mood
• Social isolation
• Poor sleep
• Trouble taking part in exercise or hobbies

Long-term outlook

The outlook is hopeful. Many people, especially teenagers, improve over months or years. Some people have symptoms for longer. A step-by-step plan, support from your healthcare team, and gentle self-care can help you live well.

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