POTS (Postural Orthostatic Tachycardia Syndrome): Symptoms, Causes, and Treatment

POTS (Postural Orthostatic Tachycardia Syndrome) makes your heart beat much faster when you stand up. You may feel dizzy, tired, or even faint. It often affects young and middle-aged women. While there's no cure, treatments like drinking more fluids, eating extra salt, and certain medications can help control symptoms.

In plain words

POTS is a condition where your heart beats too fast when you stand up. You may feel dizzy, tired, or lightheaded. It mostly affects women between 15 and 50 years old. POTS happens when your body has trouble keeping your blood pressure steady when you change positions. It often starts after an illness or injury. There is no cure, but treatments can help manage symptoms. These include drinking more fluids, eating extra salt, and sometimes medications.

What is POTS (Postural Orthostatic Tachycardia Syndrome): Symptoms, Causes, and Treatment?

Symptoms

Early symptoms

Fast heartbeat when standing: Your heart rate increases by 30+ beats per minute within 10 minutes of standing. You may feel like your heart is racing or pounding. (2) (3)
Dizziness or lightheadedness: Especially when standing up from sitting or lying down. You might need to hold onto something to keep from falling. (2)
Extreme fatigue: Feeling very tired all the time, even after sleeping. Simple activities can feel exhausting. (3)
Brain fog and trouble focusing: Difficulty concentrating or remembering things. Your thinking may feel slow or confused. (2)
Shortness of breath with activity: Feeling like you can't catch your breath, even with mild exertion like walking. (3)

Serious or emergency symptoms

Fainting (syncope): Losing consciousness when standing up or after standing for a while. This can lead to dangerous falls. Lie down immediately if you feel faint. Call for help if you hit your head when falling. (2)
Chest pain with rapid heartbeat: If you have sudden chest pain along with a very fast, irregular heartbeat, this could signal a heart problem. Seek emergency care right away. (1)

Causes

Primary causes

Autonomic nervous system dysfunction: POTS happens when your body's system for regulating blood pressure and heart rate doesn't work right when you stand up. (1)
Often follows illness or trauma: Many people develop POTS after a viral illness, surgery, pregnancy, or physical trauma. It can also appear after significant stress. (3)
Not fully understood: Doctors don't fully understand what causes POTS. Research suggests several possible factors, including low blood volume and immune system changes. (1)

Risk factors

Being female

Women are about 5 times more likely than men to develop POTS, especially between ages 15 and 50. (3)

Recent illness

Having a viral illness (like mononucleosis or COVID-19) seems to trigger POTS in some people. (3)

Other health conditions

People with certain conditions like Ehlers-Danlos syndrome, autoimmune diseases, or diabetes may be more likely to develop POTS. (3)

Diagnosis

Diagnosing POTS involves checking your heart rate and blood pressure when lying down and after standing. Your doctor may also order blood tests to rule out other conditions. A tilt table test is the gold standard — you lie on a table that slowly raises you to an upright position while your vitals are monitored.

Tilt table test

Measures how your heart rate and blood pressure change when moved from lying flat to upright position. Helps confirm POTS diagnosis. (1)

Standing test

Checks if your heart rate increases significantly when you stand up from lying down, a simple bedside test that may suggest POTS. (1)

Blood and urine tests

Rules out other conditions like anemia, thyroid problems, or dehydration that can cause similar symptoms. (1)

Treatment

Medication options

Beta-blockers

These help slow down your heart rate and may reduce palpitations and chest discomfort. (2) (4)

Fludrocortisone

Helps your body retain salt and fluid, which can improve blood pressure and reduce symptoms. (4)

Midodrine

Constricts blood vessels to help prevent blood pooling in your legs when you stand up. (2) (4)

Lifestyle and self-care

Increase fluid and salt intake: Drink 2-3 liters of water daily and increase salt to 6-10 grams (unless you have high blood pressure). This helps maintain blood volume. (1) (5)
Wear compression garments: Compression stockings or abdominal binders help prevent blood from pooling in your legs when standing. (4) (5)
Exercise gradually: Start with recumbent (lying down) exercises like rowing or cycling before progressing to upright activities. Helps improve blood flow. (5)
Sleep with head elevated: Raising the head of your bed by 6-10 inches may help reduce symptoms when you get up in the morning. (1)

Always discuss dosing and treatment changes with your own prescriber.

Possible complications

Reduced quality of life: Severe POTS symptoms can make work, school, and daily activities very difficult. Some people become housebound. (5)
Depression and anxiety: Living with chronic POTS symptoms can lead to feelings of frustration, isolation, and depression. (5)
Increased fall risk: Frequent dizziness and fainting can lead to injuries from falls, especially in older adults. (5)

When to see a doctor

Routine follow-up

See your primary care doctor if you frequently feel dizzy or lightheaded when standing, especially if your heart races. These could be signs of POTS or another condition needing treatment. (1)
Schedule a follow-up if your POTS symptoms worsen or your current treatment stops working. Your doctor may need to adjust your medications or lifestyle plan. (4)

Seek emergency care

Seek emergency care if you faint and hit your head, or if you have chest pain with your rapid heartbeat. These could signal a more serious problem. (1)
Get immediate help if you develop severe weakness on one side of your body, trouble speaking, or vision changes — these could indicate a stroke. (2)

Frequently asked questions

What is POTS?

POTS stands for Postural Orthostatic Tachycardia Syndrome. It's a condition where your heart rate increases dramatically when you stand up, often causing dizziness, fatigue, and other symptoms. It happens due to problems with how your body regulates blood flow. (1) (2)

What are the first signs of POTS?

Early signs include feeling dizzy or lightheaded when standing, a racing heartbeat when upright, extreme fatigue, and trouble concentrating. Many people first notice symptoms after standing for a while or when getting up from sitting or lying down. (2) (3)

What causes POTS?

The exact cause isn't fully understood, but POTS happens when your autonomic nervous system (which controls involuntary functions like heart rate) doesn't work properly. It often develops after an illness, trauma, or during major hormonal changes like puberty or pregnancy. (1) (3)

How is POTS treated?

Treatment focuses on managing symptoms. This usually includes drinking more fluids, eating extra salt, wearing compression garments, and gradually increasing exercise. Some people benefit from medications to control heart rate or increase blood volume. Your doctor will create a personalized plan. (4) (2)

Can POTS be cured?

There's currently no cure for POTS, but many people see improvement with treatment. Symptoms may come and go over time. Some younger patients outgrow it, while others learn to manage it long-term. Working with your doctor can help you find the best ways to control your symptoms. (1) (5)

References

Cleveland Clinic — POTS Overview source 1
MedlinePlus — POTS source 2
Dysautonomia International — What is POTS? source 3
Cleveland Clinic — POTS Treatment source 4
Dysautonomia International — Living with POTS source 5