What Is Postural Orthostatic Tachycardia Syndrome (POTS)?

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
  

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.

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 symptoms
• Procoralan (ivabradine): Slows down an elevated heart rate
• Orvaten (midodrine): Stabilizes blood pressure changes when going from sitting to standing
• Inderal 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.