Postural Orthostatic Tachycardia Syndrome (POTS)

Do you feel dizzy or lightheaded every time you stand up? These symptoms could be signs of postural orthostatic tachycardia syndrome (POTS). 

At Banner Health, we’re here to help you understand this condition and navigate its challenges. Learn more about POTS symptoms, diagnosis and treatment options and how Banner Health can help improve your quality of life with expert care.

What is POTS?

Postural orthostatic tachycardia syndrome (POTS) is a disorder that can make you feel faint or dizzy. POTS occurs when your body doesn’t adjust as it should when standing or sitting up from a seated or lying position (known as orthostatic intolerance).

POTS is a disorder of the autonomic nervous system (ANS). This system controls body functions we don’t consciously control, such as heart rate, breathing, blood pressure, digestion and body temperature. Each word of POTS has a meaning:

• Postural: related to the position of your body
• Orthostatic: related to standing upright
• Tachycardia: increased heart rate
• Syndrome: a group of symptoms 

When a person stands up, their body’s ANS will usually cause blood vessels in the lower part of your body (or legs) to narrow and push blood quickly back to the heart and the brain. Because of this response, there is little change in heart rate.

In people with POTS, however, the ANS doesn’t work in the usual way. Their blood vessels don’t tighten enough to make sure blood flows to their brain. This causes a higher-than-usual increase in heart rate, making them feel like they need to sit down.

Symptoms of POTS

While the main symptom of POTS is an increased heart rate after standing, many other symptoms have been linked to the condition, including:

• Dizziness or lightheadedness upon standing
• Fainting or near-fainting episodes
• Rapid heartbeat (tachycardia)
• Exercise intolerance
• High or low blood pressure 
• Headaches
• Feeling nervous or anxious
• Brain fog or difficulty concentrating
• Stomach pain
• Chest pain
• Difficulty falling and staying asleep (insomnia)

These symptoms can vary in intensity and can affect daily life. If you have them, see your health care provider for proper diagnosis and management.

Types and causes of POTS

The causes of POTS differ from one person to another. Researchers do not fully understand what causes POTS. However, they believe it has multiple causes, which they’ve grouped into the following subtypes:

• Neuropathic POTS is caused by damage to the small nerve fibers that help regulate blood flow and blood pressure. The nerves that should help blood vessels tighten to push blood back to the heart don’t work properly, causing blood to collect in the lower part of the body when standing up.
• Hyperadrenergic POTS is caused by overactivity of the sympathetic nervous system, which controls the fight or flight response. When standing, the body releases too much adrenaline, increasing heart rate and blood pressure.
• Hypovolemic POTS is caused by low blood volume. There isn’t enough blood circulating in the body, which makes it hard for the heart to pump blood effectively when standing.
• Secondary POTS is caused by underlying medical conditions such as diabetes, Lyme disease, Ehlers-Danlos syndrome or autoimmune disorders like lupus or Sjogren syndrome. It can also be triggered by a viral illness like COVID-19 or pregnancy.

Each type involves problems regulating blood flow and blood pressure when moving to an upright position. However, the specific underlying issues vary.

Who is at risk of POTS?

POTS can affect people of all genders and age groups. However, most cases are diagnosed in women ages 15 to 50. 

You’re at higher risk for POTS after experiencing the following stressors and life events:

• Puberty
• Pregnancy
• Following a surgery
• After a viral illness like COVID-19 or mono (mononucleosis)
• Physical trauma or head injury
• Chemotherapy
• Alcoholism

Diagnosis of POTS

Diagnosing POTS can be difficult because many symptoms may overlap with other conditions.

There is no single test to diagnose POTS, but your health care provider will review your medical history and perform a physical exam. They may run several tests, including an echocardiogram, cardiopulmonary testing, blood and urine tests, a stand test and a tilt table test.

A tilt table test is the gold standard for diagnosis. You are strapped to a table and then tilted from lying on your back into an upright position (standing) while your heart rate and blood pressure are measured.

Treating POTS

While there is no cure for POTS, there are things you can do to help manage symptoms. Your health care provider may use a combination of physical therapy, lifestyle changes and medications.

Physical therapy: Regular exercise can improve your body’s ability to handle changes in posture and blood flow. Work with a physical therapist to learn what physical activity you can do, then slowly work up from there. As your blood circulation improves, exercise intensity may be gradually increased. 

Lifestyle changes: Changes to your diet and daily life can help with your blood volume and reduce your symptoms. These can include:

• Increasing fluid and salt intake: Add a dash of table salt to your food. Snack on pretzels, olives and other salted foods. Drink plenty of water throughout the day. Your provider can advise you on how much sodium and fluids you should have each day.
• Eat small, frequent meals: Eating a large meal can make symptoms of POTS worse. Keep your nutrition balanced with lean proteins, fresh fruits and vegetables, dairy and whole grains. A registered dietitian can help you with your diet. 
• Wear compression stockings: Knee-high compression socks or stockings or footless calf sleeves, leggings and bike shorts can help prevent blood from pooling in your legs.
• Avoid long periods of standing: When you stand for a long time, blood can pool in your legs and lower body. This can lead to dizziness, fainting and a rapid heart rate.
• Get enough regular, quality sleep: Sleep is very important for overall health. Go to bed at the same time every night. Avoid daytime napping and use of technology just before bedtime. Learn more tips about getting a good night’s rest.

Medications

The U.S. Food and Drug Administration (FDA) hasn’t approved any medication for POTS treatment. However, your health care provider might prescribe medications off-label to help with your heart rate and blood pressure. These medications include:

• Beta-blockers 
• Midodrine 
• Fludrocortisone
• Selective serotonin reuptake inhibitors (SSRIs)

The long-term outlook for POTS

Most people notice their symptoms get better with medications and lifestyle changes and/or symptoms improve over time. However, symptoms may flare without warning. 

See your health care provider for regular check-ups. If you can, keep a journal to help you better identify things that may trigger symptoms. Limit activities that may trigger your POTS. Take frequent snack breaks and drink plenty of water. 

POTS may also take a toll on your mental health. Talk to a behavioral health specialist about how your symptoms impact your life. Seek the support of friends and family. Consider joining a support group to help reduce the feeling of being alone.   

Contact Us

If you suspect you or a loved one may have POTS, speak with a Banner Health specialist for a proper diagnosis and treatment. At Banner Health, we’re dedicated to providing care and support for people with POTS and other autonomic disorders.