Disclaimer: Human Health is not recommending any specific medical treatment for any particular symptom, nor providing any other medical advice. Always seek the advice of your doctor regarding any medical concern.

What is POTS?

POTS stands for postural orthostatic tachycardia syndrome. It is a disorder of the autonomic nervous system, the division of the nervous system that controls unconscious impulses like breathing and heart rate.

When we are sitting or lying down, blood can pool in the lower body. Usually, the autonomic nervous system activates a number of mechanisms to circulate this blood back to the upper body to ensure that organs like the brain have adequate blood supply. One of these mechanisms includes temporarily increasing the heart rate, before it settles back down after about 20 seconds.

For people with POTS, this nervous system response is not as effective, and so the brain doesn’t receive enough oxygen due to the blood pooling. This may lead to symptoms such as lightheadedness, dizziness, blurry vision, and fainting.

In an attempt to compensate, the heart rate continues to increase, leading to a tachycardia, which is when the heart beats significantly faster than usual.

Quick facts about POTS

• POTS is 5 times more common in females than males.
• POTS is associated with symptoms that aren’t related to postural changes, like anxiety, fatigue, and gastrointestinal problems.
• POTS is typically diagnosed in people aged 15–50 years old.

What are the common symptoms of POTS?

Common symptoms of POTS related to postural blood flow difficulties are often brought on with standing up and may resolve when sitting down. These symptoms may include:

• Lightheadedness
• Palpitations, which includes the awareness of your heart beating, or feeling the heart beat faster or harder than usual. This may also be associated with feelings of chest pain and shortness of breath.
• Vision fading in and out
• Feeling as if you are about to faint
• Headache, that may be prominent along the neck and the back of the shoulders in a ‘coat-hanger’ pattern
• Difficulty concentrating
• Flushing
• Nausea

There are other symptoms of POTS not related to postural changes, and they can vary. Some of the common symptoms may include:

• Anxiety, particularly related to heightened awareness of bodily sensations
• Fatigue
• Cognitive difficulties, such as difficulties with memory, attention, and processing information
• Gastrointestinal problems such as bloating, constipation, diarrhea, and abdominal pain
• Sleep problems

How is POTS diagnosed?

The key diagnostic feature of POTS is a persistent increase in heart rate of at least 30 beats per minute within 10 minutes of being upright. For people aged below 20 years old, the change should be at least 40 beats per minute. This may be assessed using a special test called a tilt-table test, where you are secured to a special table that can be tilted upright.

The change in heart rate should be accompanied by the postural intolerance symptoms previously mentioned, such as dizziness, vision fading, and feeling faint. The diagnosis cannot be made in the absence of these symptoms.

POTS cannot be diagnosed without checking blood pressure with postural changes. In POTS, the blood pressure does not significantly decrease with standing up. If this does occur, it is more likely to be another condition called orthostatic hypotension.

Some blood tests may be required to exclude other causes of postural symptoms.

What are the different types of POTS?

Although there is not an official categorization of different types of POTS, there are 3 classifications that have been recognized. People with POTS may fall into more than one of these categories, or may also not fit clearly into any of them.

• Hyperadrenergic: Characterized by increased levels of a hormone called norepinephrine, which usually acts on the heart and blood vessels to maintain blood pressure and circulation.
• Hypovolemic: Characterized by low blood volume.
• Neuropathic: Characterized by damage to or dysfunction of the nerves, particularly in the lower limbs.

What are the different treatments available for POTS?

Most treatments for POTS are aimed at reducing the effect that symptoms have on daily functioning. Here are some examples of lifestyle management strategies for POTS:

• Increasing fluid and salt intake to increase blood volume and improve blood flow
• Physical exercise to increase blood flow around the body
• Avoiding prolonged inactivity and staying upright as much as possible
• Physical behaviors such as moving the legs, shifting weight, and tensing muscles to improve blood flow back from the legs
• Counselling and cognitive behavioral therapy
• Compressive garments like socks to improve blood flow

Some clinicians may recommend pharmacological treatment based on the severity of POTS symptoms. These may include:

• Beta blockers, a type of medication that acts on the heart and blood vessels to reduce heart rate
• Midodrine, a medication that increases blood pressure by tightening the blood vessels
• Fludrocortisone, a medication that increases the retention of sodium and water to increase blood volume
• Pyridostigmine, a medication that increases the activity of nerves that control muscles, to help pump blood back from the lower extremities

What support and resources are available?

There are various online support resources for people with POTS:

Dysautonomia Support Network is an organization that provides education, resources and support communities for people with conditions like POTS.

Standing Up To POTS is a research, advocacy, and support organization.

Dysautonomia International offers regional support groups worldwide

Where can I find the latest information on clinical trials for POTS?

ClinicalTrials.gov is a U.S. database that holds records for past, current, and future clinical trials worldwide. You can use the database to search for POTS clinical trials.

What’s the latest news and research on POTS?

Increasing recognition of POTS means that research in this area is progressing. Here’s a collection of recently published studies:

Novel brain SPECT imaging unravels abnormal cerebral perfusion in patients with postural orthostatic tachycardia syndrome and cognitive dysfunction

Long‐Term POTS Outcomes Survey: Diagnosis, Therapy, and Clinical Outcomes

Postural Tachycardia Syndrome (POTS) Symptom Burden: Frequency, Severity, and Impact on Activities of Daily Living

Here are some recent news articles that mention POTS:

Gender bias in POTS diagnosis reveals hidden impact

Study shows link between COVID-19 and rise in POTS diagnoses

New clinical trial offers hope for POTS patients

Sources

1. UpToDate: Postural tachycardia syndrome. Available at: https://www.uptodate.com/contents/postural-tachycardia-syndrome#H3487578108

2. National Library of Medicine. National Center for Biotechnology Information. Postural Tachycardia Syndrome – Diagnosis, Physiology, and Prognosis. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6113123/

‍