What is postural orthostatic tachycardia syndrome (POTS)?
Postural orthostatic tachycardia syndrome, also known as POTS, is when your body doesn’t adjust in the way it should to standing or sitting up after lying down. When you stand up, your heart rate usually rises a little to keep enough blood flowing to your brain and heart, while it also moves down into your trunk and legs.
But if you have POTS, your heart rate speeds up a lot more than it should, and this can make you feel dizzy or faint.
This abnormal response is caused by a problem with the part of your nervous system that controls automatic body functions, like your heart rate, breathing and digestion. And while POTS itself isn’t usually treated, the symptoms it causes can often be managed by making lifestyle changes, and sometimes, taking medication.
POTS has several other names, including postural tachycardia syndrome, postural autonomic tachycardia, chronic orthostatic intolerance and idiopathic orthostatic intolerance, but they all refer to the same condition.
What are the symptoms of POTS?
POTS affects people differently. Some may have mild symptoms, while others may have symptoms that noticeably affect their daily life. These symptoms may appear as soon as you stand or sit up, or they may take a few minutes to begin.
These symptoms include:
- heart palpitations
- dizziness, light-headedness and, less commonly, fainting
- grey vision
- shaking and feeling weak
- shortness of breath
- chest pain
- difficulty concentrating and thinking
While many symptoms of POTS are triggered by changing position, you may also have some symptoms that are there at other times of the day. These include:
- feeling tired
- chest pain
- cold or tingling feet
- your skin becoming red (flushing)
- feeling sick (nausea), bloating of your tummy and diarrhoea
- trouble sleeping
When to see a doctor about POTS
There are lots of conditions that can cause the same symptoms as POTS. Some of these are more serious than others, so see a doctor as soon as possible if you have any of the symptoms listed above.
You should go to a hospital or emergency department immediately if you have any of the following symptoms, as they may be a sign of a more serious condition:
- heart palpitations or a fast heartbeat that last for more than a few minutes
- fainting or almost fainting
- feeling confused or having trouble understanding what others are saying
- weakness of 1 side of your body, trouble balancing and/or changes in your vision
- any shortness of breath and chest pain
- your existing symptoms suddenly get worse, feel very bad or you feel very unwell
What are the causes of postural tachycardia syndrome (POTS)?
Most of the time, POTS has no clear cause, but it can sometimes be triggered by a viral infection, traumatic event or pregnancy.
POTS has also been linked to some medical conditions, including:
- autoimmune conditions, like lupus and Sjögren’s syndrome
- chronic fatigue syndrome
- Lyme disease
- multiple sclerosis (MS)
- Ehlers-Danlos syndrome
- poisoning with alcohol or some metals
It also seems to be more common in people born female than male – although POTS can affect anyone.
How can you tell if you have POTS?
Specific changes in your heart rate on standing or sitting up will usually make a doctor suspect POTS. They’ll usually diagnose the condition if your heart rate increases by 30 beats per minute (bpm) or more if you’re 20 or older, and by 40 bpm or more if you’re 19 or younger.
This increase should:
- happen within 10 minutes of standing up
- last longer than 30 seconds
- happen alongside some of the symptoms of POTS mentioned above
While these telltale changes in your heart rate are often enough to diagnose POTS, in some cases, you may need tests – often to rule out other causes of your symptoms. These tests may include the tilt table test and the active stand test.
Tilt table test for POTS
The tilt table test involves lying on a special bed that can be tilted upright. You’ll usually have your heart rate and blood pressure measured while lying flat, and then again while the bed is slowly tilted upright.
Active stand test for POTS
If you have an active stand test, you’ll usually be asked to lie flat for a few minutes and then your heart rate and blood pressure will be measured. You’ll then be asked to stand up and your heart rate and blood pressure will be measured a few more times over the next 10 minutes.
Other tests for POTS
Aside from the tilt table and active stand test, other tests you may need include:
How is POTS treated?
There’s no cure for POTS, but it often gets better on its own or with treatment. This treatment may involve lifestyle changes only or, less often, medication.
Lifestyle changes for POTS
Very often, lifestyle changes, centred on diet, exercise and changing some of your daily habits, are enough to improve any POTS symptoms you may have. The most commonly recommended changes include:
- drinking plenty of fluids – aim for your pee to be a light yellow colour
- avoiding or cutting down on alcohol and caffeine – these can make your symptoms worse
- adding more salt to your diet – only do this if a doctor tells you to. Extra salt may be harmful to people with some conditions, like kidney disease and heart disease
- wearing compression stockings – wear these up to your waist to help keep your blood circulating well
- raising the head end of your bed, so you aren’t lying flat when you sleep
- not standing or sitting for long periods of time
- standing up slowly after sitting or lying down
- exercising often – but take care to avoid overdoing things as this can make your symptoms worse. Stick to light or moderate exercise, and increase how much you do slowly. Read more about how much physical activity you need to stay healthy
Some people notice that certain factors, like eating, doing a lot of exercise, feeling hot, being dehydrated or drinking alcohol, make their symptoms worse. If this is true for you, avoiding these triggers may also help to reduce your symptoms.
Medical treatment for POTS
If lifestyle changes don’t help your symptoms, a doctor may give you medication, like beta blockers, antidepressants that work on your nervous system, or steroids that reduce the amount of sodium you lose in your pee. But bear in mind that these medications don’t treat POTS itself, they just help to manage the symptoms.
What can I expect in the long term with POTS?
Most people with POTS notice their symptoms get better on their own in time or with lifestyle changes and/or medication.
If you find that your symptoms aren’t getting better or they’re getting in the way of your daily activities, speak to a doctor for advice on the best way to manage your symptoms. They may also be able to put you in contact with support groups in your local area if you’d like to connect with other people with POTS.
Your questions answered
POTS and COVID-19 – is there a link?
“POTS can sometimes begin after a viral infection like COVID-19. Some researchers think that COVID-19 may be a trigger for POTS, as some people have developed POTS after having COVID-19. If you think you may have developed POTS after having had COVID-19, see a doctor.” – Answered by Dr Aleem Qureshi from the Healthily Medical Team
What's the best way to lose weight with POTS?
Eating a healthy, balanced diet and doing regular exercise is the safest way to lose weight and keep it off, whether you have POTS or not. But if you have POTS, doing a lot of exercise or very strenuous exercise can make your symptoms worse, so focus on doing light to moderate exercise and slowly increasing how much you do. Speak to a doctor and nutritionist for specific advice on the best way to lose weight if you have POTS.
Why do I get POTS symptoms after eating?
Some people find that the symptoms of POTS are triggered by eating – especially eating refined carbohydrates, like sugar and white flour. It’s thought that this is because when you eat, more blood flows to your stomach and bowels as part of the digestion process. This means that there’s less blood flowing to the rest of your body to keep your blood pressure and heart rate up, and this may make POTS symptoms worse when you change position. If eating makes your symptoms worse, try having a rest after eating or getting up slowly after eating.
- POTS is when your heart rate speeds up more than it should when you stand or sit up
- it can cause symptoms like palpitations, dizziness and lightheadedness
- POTS can’t be cured, but it often gets better on its own over time
- lifestyle changes like drinking lots of fluids and standing up slowly after lying down can help to improve your symptoms
- if lifestyle changes don’t help, a doctor may recommend medication