What is Postural Orthostatic Tachycardia Syndrome (POTS)?

Quoted and adapted from the Cleveland Clinic

Postural Orthostatic Tachycardia Syndrome (POTS) is a condition that affects how your body regulates blood flow and heart rate when you change positions—especially when you go from lying down or sitting to standing up. It's a form of **orthostatic intolerance**, meaning the body struggles to manage blood pressure and circulation in upright positions.

What does POTS stand for?

Each part of the name describes a part of the condition:

Postural– Related to body position
Orthostatic – Related to standing upright
Tachycardia – A heart rate faster than 100 beats per minute
Syndrome– A group of symptoms that occur together

Normally, your autonomic nervous system controls heart rate and blood pressure, ensuring steady circulation regardless of your posture. In POTS, this balance is disrupted—causing the heart to race and blood pressure to fluctuate when standing. This leads to symptoms like dizziness, fatigue, and even fainting.

Who is Affected by POTS?

POTS primarily affects women between the ages of 15 and 50, but it can impact anyone.

It often develops after:

A viral illness (e.g., mononucleosis)
Surgery or trauma (e.g., head injury)
Pregnancy
Autoimmune diseases such as lupus, Sjögren’s syndrome, or celiac disease

An estimated 1 to 3 million people in the U.S. are affected by POTS.



How POTS Affects the Body

When a person without POTS stands up, the body compensates for the pull of gravity by tightening blood vessels and slightly increasing heart rate—keeping blood flowing to the brain. People with POTS, however, experience excessive blood pooling in the lower body, which causes a **disproportionate increase in heart rate** and a cascade of symptoms.

Common symptoms include:

Lightheadedness or dizziness
Rapid heart rate (palpitations)
Fatigue and brain fog
Fainting or near-fainting
Chest pain and shortness of breath
Shakiness and excessive sweating
Cold or discolored extremities
Sleep disturbances

Symptoms can worsen with heat, prolonged standing, menstruation, illness, or exercise.

Is POTS Serious?

POTS is not life-threatening, but it can significantly impact quality of life. The good news is that many people see improvement over time, especially with appropriate lifestyle changes, treatment, and support.

What Causes POTS?

The exact cause isn’t fully understood, but researchers have identified several subtypes:

Neuropathic POTS:*Nerve damage affecting blood vessel function
Hyperadrenergic POTS: Overactive sympathetic nervous system
Hypovolemic POTS: Low blood volume

There is also growing evidence that autoimmunity plays a role in many POTS cases.



How is POTS Diagnosed?

POTS can be difficult to diagnose due to its wide range of symptoms. Key diagnostic steps include:

Medical history and physical exam
Tilt table test– Measures heart rate and blood pressure changes from lying to standing
Additional tests may include:

Blood and urine tests
Autonomic function tests (like QSART)
Breathing tests
Skin nerve biopsy

POTS Treatment & Management

There is no single cure for POTS, but a combination of lifestyle changes, exercise, diet, and medications can help manage symptoms.

1. Exercise & Physical Conditioning

Regular physical activity is essential and often starts with reclined aerobic exercises like:
Swimming
Recumbent biking
Rowing

Other strategies:

Isometric exercises (muscle contractions without movement)
Slow transitions from lying to sitting/standing
Gradual walking and step-count goals
Gentle yoga and stretching

2. Diet & Hydration

People with POTS—especially the hypovolemic type—may benefit from:

3,000–10,000 mg of sodium per day
2–2.5 liters of fluids daily
Eating small, frequent meals
High-fiber and complex carbohydrates
Healthy salty snacks (e.g., broth, olives, sardines)

3. Medications (Prescribed Off-Label)

These may help in managing symptoms:
Fludrocortisone – Boosts blood volume
Pyridostigmine – May lower heart rate
Midodrine – Tightens blood vessels
Beta-blockers – Can reduce heart rate

Always work closely with your healthcare provider to manage medications.

Additional Self-Care Tips

Monitor your pulse and blood pressure regularly
Sleep well : Elevate your bed, avoid screens before bed, and maintain a consistent schedule
Avoid alcohol : It can worsen dehydration and symptoms
Prevent flare-ups by managing heat exposure and avoiding prolonged standing
Use compression garments to support circulation
Stay emotionally supported : Support groups and counseling can help

Living with POTS: Outlook and Quality of Life

Most people with POTS improve over time—about 80% see symptom relief with proper treatment. The condition does not shorten life expectancy, though it may take years to manage effectively.

Being informed, tracking symptoms, and maintaining an open dialogue with your healthcare team can make a significant difference in your health and quality of life.



Source:[Cleveland Clinic – Postural Orthostatic Tachycardia Syndrome (POTS)](https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots)