What Is POTS (Postural Orthostatic Tachycardia Syndrome)?
Key takeaways:
If you have postural orthostatic tachycardia syndrome (POTS), your heart rate increases rapidly when you stand up, and it stays high for several minutes. You may feel dizzy or weak when this happens.
The exact cause of POTS is unknown.
Treatment includes careful and progressive exercise, good fluid intake, and added salt in the diet. More severe cases may require medication.
Have you ever felt dizzy after standing up too fast? It’s a common sensation, and it tends to go away quickly. But some people experience it for longer and with a rapid and persistent rise in heart rate. This is called “postural orthostatic tachycardia syndrome” (POTS).
POTS has only been recognized as a medical disorder since the early 1990s, so many people aren’t aware of this condition. POTS mostly affects teenage girls and women under 50, although about 20% of people with the syndrome are male.
We still don’t know exactly why an individual develops POTS, but the good news is that treatment is available, and about half of people will recover within a few years after diagnosis. Here we’ll review symptoms of POTS, how it’s diagnosed, and what you can do about it.
What are the symptoms of POTS?
Postural orthostatic tachycardia is medical jargon for a fast heart rate that happens when you stand up. Beyond the fast heart rate, POTS has a very specific set of symptoms that last for several minutes or longer and happen within 10 minutes of standing. These symptoms include:
Lightheadedness
Weakness
Blurry vision
Flushing
POTS symptoms tend to be worse in the morning. Among people with POTS, 1 in 3 will experience fainting at some point, although most episodes don’t cause you to pass out.
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What causes it?
No one knows exactly why POTS happens. It appears that it may be due to a combination of factors.
One theory is that for some people, an immune reaction to a virus might harm normal nerve function. Some people with POTS have evidence of damage to nerve fibers that supply the legs. This damage may be due to the effects of viral infection, and it could affect the way the body reacts to changes in position.
Other people seem to have overactive sympathetic nervous systems. This means they have a very sensitive flight-or-fight reaction to stress, which can affect heart rate. People with POTS may be more likely to become dehydrated. Because the symptoms of POTS can make it difficult to do normal activities, people with POTS often avoid exercise. This is known as “deconditioning,” and it may actually make the problem worse.
How is POTS diagnosed?
As we mentioned earlier, the main feature of POTS is a fast heart rate that happens when you stand up. But there are more detailed criteria that help to make the diagnosis. These include:
Increase in heart rate by over 30 beats per minute when moving from lying down to standing up, lasting for at least several minutes
No significant drop in blood pressure with this change in position
Symptoms have been present for at least 6 months
POTS symptoms often get worse with:
Heat exposure
Alcohol
Menstruation
Heavy exercise
A POTS diagnosis requires that there are no other clear explanations for your symptoms. That’s because other things like pain, dehydration, diarrhea, or medications or supplements can also speed up the heart rate.
If you have POTS, you are more likely to have other health problems, including:
Autoimmune disorders like lupus or rheumatoid arthritis
Anxiety
Sleep disorders
Exercise intolerance (inability to exercise at expected levels)
Providers can usually confirm a diagnosis after reviewing your symptoms, heart rate changes, and health conditions that go along with POTS. But it’s important to rule out other issues. To do this your healthcare provider may order tests such as:
Blood work to check your electrolytes, thyroid gland function, and blood count
An electrocardiogram (ECG) to look for changes in the heart’s electrical pattern
An ambulatory heart monitor, also known as a Holter monitor, to track the heart rhythm and rate over several days
Although it’s less common, your provider may refer you to a neurologist for more specialized testing of the nervous system. And if your provider suspects a heart condition, they may refer you to a cardiologist.
Is POTS a side effect of long COVID?
Although COVID-19 is a fairly new virus, we are learning more about it each day. The virus has already been linked to cases of POTS. As such, this may be one piece in the puzzle that helps us to understand long COVID syndrome. It’s unclear how many people with long COVID have POTS, but research is ongoing.
How serious is POTS?
POTS is rarely a life-threatening condition, although it can have a negative impact on quality of life. Most people with POTS will never pass out, but it’s important to sit or lie down if you feel dizzy or lightheaded, since falling does put you at risk for injury.
When it comes to employment, POTS may limit your options. It can be problematic if your work requires that you spend time outdoors in the heat, stand for long periods of time, or go without breaks for food or water. If you have POTS and have work-related concerns, be sure to speak to your provider. There may be opportunities for physical therapy, workplace accommodations, or other options that will allow you to continue in your current job.
Many people recover slowly over time. This is especially true for people who develop POTS as teens or due to viral infection. For some, a careful exercise program aids in recovery.
When should you see a doctor about POTS symptoms?
It makes sense to see your medical provider if you have symptoms that are frequent, affect your quality of life, or have caused you to fall or to pass out. Not all symptoms of dizziness are from POTS, even if they happen when going from seated to standing. For instance, vasovagal syncope shares many of the same features. Anemia, thyroid conditions, and a variety of other health problems may also feel very much like POTS. A simple checkup can often sort out where the symptoms are coming from.
How is it treated?
Since we don’t really know exactly why POTS happens, treatment focuses on managing the symptoms, especially the fast heart rate that happens with standing. Careful, regular exercise and good hydration can help.
A study of 251 people living with POTS found that mild to moderate aerobic exercise along with gentle strength training helped people feel better. The program also recommended increasing salt and fluids. By 3 months, 70% of the people who participated had improved so much that they no longer met the criteria for a POTS diagnosis.
If you have POTS, there are a number of things you can do to help keep the problem under control. These include:
Get up slowly from a seated or lying position.
Drink plenty of fluids.
Add more salt to your diet, unless you have high blood pressure or a heart condition.
Avoid or limit alcohol intake.
Avoid standing for long stretches of time.
Try to stay indoors on hot days.
Cross your legs tightly or squat down when you have symptoms.
Wear support hose if possible.
Consider elevating the head of your bed by 4 to 6 inches.
Exercise safely by swimming, using a recumbent bike, or a seated rower to build up your endurance.
If you feel like you’re going to pass out, sit or lie down to avoid falling and hurting yourself.
In more severe cases, your provider may recommend prescription medication to reduce your heart rate or to help your body retain fluid. But most of the time people with POTS don’t need medications.
The bottom line
Most of the time you can successfully manage POTS without medication by following the suggestions we’ve outlined above. If your symptoms are frequent or scary, check in with your healthcare provider to get a clear diagnosis and a management plan in place. There’s a good chance your symptoms may decrease within a few years.
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References
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