Health Conditions A-Z Cardiovascular Disorders Heart Disease What Is Postural Orthostatic Tachycardia Syndrome (POTS)? By Rachel Nall Rachel Nall Rachel works as a CRNA where she provides anesthesia care across the lifespan, including pediatric anesthesia, with a primary focus on orthopedic anesthesia. She is also an Assistant Professor at the University of Tennessee-Chattanooga, where she is the Simulation Coordinator for the nurse anesthesia program. Rachel loves teaching, whether it's in-person or through her writing. health's editorial guidelines Published on April 19, 2023 Medically reviewed by Yasmine S. Ali, MD, MSCI Medically reviewed by Yasmine S. Ali, MD, MSCI Yasmine S. Ali, MD, MSCI, FACC, FACP, is a board-certified preventive cardiologist, clinical lipidologist, and president of the medical writing service LastSky Writing, LLC. learn more In This Article View All In This Article Types Symptoms Causes Diagnosis Treatment Related Conditions Living With POTS Frequently Asked Questions Postural orthostatic tachycardia syndrome (POTS) is a condition that causes you to feel lightheaded or dizzy and increases your heart rate when you go from a sitting to a standing position. While the severity of your condition can vary, your symptoms can sometimes be severe enough to affect your ability to carry out certain daily tasks and cause you to experience falls that can lead to injuries. An estimated 0.2% of the U.S. population has a POTS diagnosis. People assigned female at birth and are of childbearing age are the most likely to experience the condition. However, symptoms of POTS can start as early as age 14. The exact cause of POTS is unknown, however, treatment such as lifestyle changes and medication can help you better manage your condition. Types How POTS develops can vary from person to person. Some people can experience an acute and severe onset of symptoms, while others may have mild symptoms that worsen over time. You can also have one of two types of POTS: neuropathic or hyperadrenergic. It's important to note that neuropathic POTS is much more common. Neuropathic POTS: Causes low blood pressure and an elevated heart rate Hyperadrenergic POTS: Causes an increase in both your blood pressure and heart rate Symptoms The primary symptom of POTS is a heart rate that increases by 30 beats per minute or more when you go from a sitting or lying down position to a standing position. Your heart rate will typically go back to normal when you return to a resting position. You might also experience symptoms such as: Fatigue Dizziness Headache Nausea Trouble thinking Heart palpitations (or, a racing heart) Blurred vision Body weakness Difficulty sleeping Charday Penn / Getty Images Causes Experts don't know exactly what triggers POTS symptoms. Some research suggests that POTS occurs after a health-related event such as a(n): Concussion Infection COVID-19 Prolonged bed rest Major surgery Trauma Pregnancy However, POTS can also occur without having an underlying condition that caused your symptoms. In some cases, POTS can happen as a result of an autonomic system disorder (a condition that affects your nervous system) and hypervolemia (a condition where you have too much fluid overload in your body). The autonomic nervous system controls activities such as heart rate, blood pressure, and digestion. Being hypovolemic can make a person more susceptible to heart rate increases when going from lying to standing. Symptoms of POTS You Should Know Diagnosis If you suspect you may have POTS or are noticing a change in your health, it's good practice to visit your healthcare provider for testing. At your appointment, your provider will ask for your medical history to learn more about your symptoms, lifestyle habits, and current medication you're taking. Conditions that may be similar to POTS include dehydration, hypothyroidism, pulmonary embolism, or unexplained rapid heart rate. In some cases, providers can misdiagnose POTS as having an anxiety disorder. Because there are so many conditions that can mimic symptoms of POTS, there is a slight chance that you don't receive a POTS diagnosis right away. However, that's why testing is important to help you get an accurate diagnosis. Some tests your healthcare provider may order to confirm or rule out POTS include: Active stand test: An active stand test involves having you lie down for at least 10 minutes and then standing after the 10 minutes are over. Your provider will then take your blood pressure and heart rate with each position change. Laboratory tests: Laboratory tests such as a complete blood count, thyroid function tests, and metabolic testing can help your provider rule out other medical conditions. Electrocardiogram: An electrocardiogram (ECG or EKG) helps your provider determine if you have an abnormal heart rate or rhythms that may be causing your symptoms. If the results of these tests are inconclusive (or, a conclusion on a diagnosis can't be made right away), your provider can order additional testing. Treatment Unfortunately, there is no cure for POTS at this time. Instead, the goal of treatment is to reduce symptoms. Generally, your provider will recommend lifestyle changes to help you manage your condition on your own. They may suggest habits such as: Drinking enough water each day Raising the head of your bed to at least 30 degrees before you get up Following a specialized exercise routine Wearing compression socks to encourage the return of blood flow to your heart after standing If your symptoms don't improve with these changes, your healthcare provider may prescribe medications to treat POTS. Your provider can choose from several medications, based on your symptoms and the severity of your condition. These medicines include: Astonin (fludrocortisone): Helps increase blood volume and reduce symptomsProcoralan (ivabradine): Slows down an elevated heart rateOrvaten (midodrine): Stabilizes blood pressure changes when going from sitting to standingInderal XL (propranolol): A beta-blocker that can help reduce your heart rate In addition to these medications, a healthcare provider may recommend behavioral and cognitive therapy. These therapies can help reduce anxiety and fear related to the experience of POTS symptoms. If you have severe symptoms, such as fainting related to changes in your heart rate, your provider may also recommend a pacemaker to help monitor and stabilize your heart rate. Related Conditions POTS is a syndrome that can commonly co-occur with other medical conditions and symptoms. With POTS, you may be at an increased risk of experiencing: Headaches Nausea Sleep problems Abdominal pain Anxiety About 15% of people with POTS may also have an underlying autoimmune condition such as Sjogren's syndrome and fibromyalgia. Living With POTS Receiving a POTS diagnosis can feel scary, especially because symptoms can affect your daily activities and your quality of life. It's important to note that an estimated 50% of people with POTS experience a significant reduction in their symptoms within one to three years after receiving their diagnosis. However, for those who are still experiencing symptoms after this time period, treatments and therapies are available to help you manage your condition. Keep in mind: research on POTS remains ongoing and further treatments may become available in the future. Frequently Asked Questions What causes POTS flare-ups? POTS flare-ups can occur after viral infections (including COVID-19), surgery, traumatic brain injury, or other conditions that can stress the body. Can you drive with POTS syndrome? POTS symptoms range in severity. Those with severe symptoms may find they are unable to drive when they are experiencing symptom flare-ups. What age does POTS syndrome start? Normally, people with POTS receive a diagnosis during their childbearing years. However, symptoms can develop as early as age 14. Why does salt help POTS syndrome? Those who take the medication Astonin (fludrocortisone) for POTS symptoms usually eat a higher salt diet because the medication causes you to lose salt at a higher rate than normal. Was this page helpful? Thanks for your feedback! Tell us why! Other Submit 5 Sources Health.com uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Vernino S, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1. Auton Neurosci. 2021;235:102828. doi:10.1016/j.autneu.2021.102828 Bryarly M, Phillips LT, Fu Q, Vernino S, Levine BD. Postural orthostatic tachycardia syndrome: JACC focus seminar. J Am Coll Cardiol. 2019;73(10):1207-1228. doi:10.1016/j.jacc.2018.11.059 Sebastian SA, Co EL, Panthangi V, et al. Postural orthostatic tachycardia syndrome (POTS): An update for clinical practice. Curr Probl Cardiol. 2022;47(12):101384. doi:10.1016/j.cpcardiol.2022.101384 Kichloo A, Aljadah M, Grubb B, Kanjwal K. Management of postural orthostatic tachycardia syndrome in the absence of randomized controlled trials. 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