When your heart races and blood flow changes on standing
What is POTS?
Postural Orthostatic Tachycardia Syndrome (POTS) is a condition that affects the way your heart and blood vessels respond when you move from lying down or sitting to standing. People with POTS often experience a rapid increase in heart rate and may feel dizzy, lightheaded, fatigued, or have palpitations. These symptoms occur because the autonomic nervous system, which normally regulates heart rate and blood pressure, does not respond correctly, making it difficult for blood to circulate efficiently when upright.
Who is affected?
POTS can develop in anyone but is most common in women aged 15 to 50. It may appear after a viral illness, surgery, pregnancy, physical trauma, or in association with autoimmune conditions like lupus or Sjogren’s syndrome. Each person’s experience of POTS is unique, with symptoms varying in frequency and intensity over time.
Common Symptoms
Rapid heartbeat or palpitations upon standing
Dizziness, lightheadedness, or fainting
Fatigue or “brain fog”
Shortness of breath or chest discomfort
Shakiness, sweating, nausea, or bloating
Pale or discoloured hands and feet when upright
Sleep disturbances due to palpitations or sweating
Symptoms often worsen with heat, standing for long periods, strenuous activity, illness, or hormonal changes.
Causes and Subtypes
The exact cause of POTS is not fully understood, but it is thought to involve multiple mechanisms, including:
Neuropathic POTS: Poor nerve signaling to blood vessels, mainly in the legs and abdomen
Hyperadrenergic POTS: Overactive sympathetic nervous system
Hypovolemic POTS: Low blood volumeSome evidence also suggests an autoimmune component may play a role.
Diagnosis
Diagnosing POTS can be challenging due to the variety of symptoms. Healthcare providers may use:
Detailed medical history and physical examination
Heart rate and blood pressure monitoring while lying, sitting, and standing
Tilt table testing to observe cardiovascular responses to changes in posture
Blood tests, autonomic function tests, or specialized nerve studies to rule out other conditions
Treatment and Management
While there is no cure, POTS can be managed effectively with a combination of lifestyle measures, physical conditioning, and sometimes medications:
Lifestyle Adjustments: Staying well-hydrated, increasing salt intake (if advised), avoiding prolonged standing, and managing temperature extremes
Exercise: Gradual, structured programs such as recumbent cycling, swimming, or strength exercises targeting core and leg muscles
Compression Therapy: Wearing compression stockings to support blood return from the legs
Medications: Off-label medications may be used to improve blood volume, heart rate, or blood vessel tone, including fludrocortisone, beta-blockers, midodrine, or pyridostigmine
Living with POTS
POTS can impact daily life, but many people improve over time with careful management. Monitoring heart rate and blood pressure, prioritizing sleep, pacing activity, and seeking support through counseling or POTS support groups can make a significant difference. Patients are encouraged to work closely with healthcare providers who understand POTS to tailor treatment to their individual needs.
Prognosis
POTS is not life-threatening, and life expectancy is normal. Most patients experience improvement over time, though some may have ongoing symptoms that require continued management. Awareness of triggers and careful lifestyle planning are key to minimizing flare-ups and improving quality of life.