Postural tachycardia syndrome

Overview

Postural tachycardia syndrome, often called PoTS, is a condition where your heart rate increases too much when you stand up. This causes symptoms like dizziness, fainting, and fatigue. It happens because the body's automatic nervous system (which controls things like heart rate and blood pressure) does not work properly after you change position.

PoTS is becoming more recognised. It may affect about 1 in 100 people, though many are not diagnosed. Awareness has increased in recent years.

PoTS can affect people of any age, but it is most common in women between the ages of 15 and 50. It can also affect men, children, and older adults.

Symptoms

Common symptoms

• Dizziness or lightheadedness when standing up
• Feeling like you might faint (presyncope) or actually fainting
• A racing or pounding heartbeat (palpitations)
• Extreme tiredness (fatigue) that is not relieved by rest
• Difficulty concentrating, feeling 'foggy' in the head
• Nausea or bloating
• Shakiness, especially in the legs
• Headaches or neck pain

Symptoms in children

• Children may have the same symptoms as adults, but they might also complain of stomach ache or feel too tired to go to school.
• They may have trouble paying attention in class because of brain fog.

Symptoms in older adults

• Older adults with PoTS may notice more falls or unsteadiness.
• They may feel generally weak or have symptoms that are mistaken for normal ageing.

Causes

Main causes

• Problems with the autonomic nervous system (the part of the body that controls automatic functions like heart rate and blood pressure).
• The blood vessels do not tighten enough when you stand, so blood pools in the legs and the heart has to beat faster to pump it back up.
• PoTS can develop after a viral illness, pregnancy, surgery, trauma, or during times of hormonal change.

Risk factors

• Being female, especially between ages 15 and 50
• Having a family history of PoTS or similar conditions
• Having certain connective tissue disorders, such as Ehlers-Danlos syndrome
• Having an autoimmune disease or a history of chronic fatigue syndrome

When to see a doctor

See a doctor urgently if:

• If you faint and hit your head or feel confused afterwards
• If your heart feels like it is racing or skipping beats for a long time
• If you are unable to stand or walk because of dizziness

Book a routine appointment if:

• If you often feel dizzy or faint when standing up
• If you have extreme fatigue that does not get better with rest
• If you notice a fast heartbeat upon standing that affects your daily life

Diagnosis

A doctor will listen to your symptoms, check your medical history, and do a physical exam. The main test for PoTS measures your heart rate and blood pressure when you change from lying down to standing up.

Tests that may be done

• Active stand test: your heart rate and blood pressure are measured while you lie down, then immediately after standing, and again after 2, 5, and 10 minutes.
• Tilt table test: you lie on a table that tilts upright, while your heart rate and blood pressure are monitored. This is often done in a hospital or clinic.
• Blood tests to rule out other causes, such as anaemia or thyroid problems.

What to expect at your appointment

Your doctor or specialist will explain the tests. You may be asked to stop certain medications beforehand. The tests are not painful, but you might feel dizzy or faint during them. This is expected and will be monitored.

Treatment

There is no cure for PoTS, but the condition can be managed. Treatment focuses on reducing symptoms and helping you stay active. Your doctor will tailor the plan to you, which may include lifestyle changes and sometimes medications.

Self-care at home

• Drink plenty of fluids – aim for 2 to 3 litres a day – to increase blood volume.
• Increase salt intake (unless you have high blood pressure or heart disease); ask your doctor first.
• Wear compression stockings to help push blood back up from your legs.
• Raise the head of your bed a few inches to help your body adjust to upright positions.
• Avoid standing for long periods. If you must stand, move your legs or shift your weight.
• Eat smaller, more frequent meals to prevent blood flowing to your digestive system all at once.

Medical treatments

If lifestyle changes are not enough, a specialist may prescribe medicines that help regulate heart rate, support blood pressure, or increase blood volume. These are individualised, and your doctor will discuss the options and possible side effects with you. Never take any medication for PoTS without medical advice.

When is surgery considered?

Surgery is not used to treat PoTS. In rare cases, a procedure called a pacemaker may be considered, but this is not common and only after careful evaluation by a specialist.

Living with this condition

Living with PoTS means learning to manage your energy and symptoms. Plan your day around times when you feel best. Use pacing: do a little activity, then rest. If you feel dizzy, sit or lie down quickly. You may need to avoid very hot showers, crowded places, and sudden movements.

Lifestyle tips

• Stay well hydrated – carry a water bottle with you.
• Get enough sleep and have a consistent sleep schedule.
• Avoid alcohol and caffeine, as they can worsen symptoms.
• Keep cool by using fans or staying out of direct heat.
• Wear loose clothing and avoid tight waistbands that can trap blood in your legs.

Diet and exercise

Increase your salt and fluid intake as advised by your doctor. For exercise, try activities you can do lying or sitting, such as swimming, rowing, recumbent cycling, or floor exercises. Avoid high-impact or upright exercises like running, which can trigger symptoms. Start slowly and build up under guidance.

Mental health and emotional wellbeing

Living with a chronic condition can be stressful and may cause anxiety or depression. It is normal to feel frustrated or worried. Talk to your doctor about support, and consider seeing a counsellor or therapist. Your mental health is just as important as your physical health.

Prevention

There is no known way to prevent PoTS. However, if you have early symptoms, getting diagnosed and managing the condition well can help reduce its impact on your life.

Complications

If left untreated

• Frequent fainting, which increases the risk of injury from falls
• Persistent fatigue that makes it hard to work or study
• Reduced quality of life due to ongoing dizziness and brain fog
• Anxiety or depression from dealing with the symptoms

Long-term outlook

With the right treatment and self-care, most people with PoTS see improvement in their symptoms and are able to live full, active lives. It may take time to find the best plan for you, but many people manage their condition well.

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