Understanding Postural Tachycardia Syndrome (POTS)

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Written By Dr. Adam Mueller

Written and medically verified by Dr. Adam Mueller, a board-certified internal medicine and cardiology expert. His career is focused on the study and promotion of health and preventive care.

Have you ever felt dizzy or lightheaded when you stand up too quickly? Imagine feeling that way almost every time you stand up, coupled with a racing heart and a wave of fatigue. This is a daily reality for those living with Postural Tachycardia Syndrome (POTS). It’s a condition that might sound complex, but it affects many people, often without them even knowing it.

What Exactly is POTS?

POTS stands for Postural Tachycardia Syndrome. In simpler terms, it’s a disorder where a change from lying down to standing up causes an abnormally large increase in heart rate. This increase comes with a bunch of uncomfortable symptoms like dizziness, fainting, and tiredness. It’s part of a group of disorders that involve orthostatic intolerance – difficulty standing upright without symptoms.

POTS Through History: More Than Just a Name

POTS has been known by many names in the past, such as neurocirculatory asthenia, mitral valve prolapse syndrome, and even soldier’s heart. Each name reflects a different understanding of the condition through history. But at its core, it’s always been about how the body reacts, or rather overreacts, when you stand up.

Distinguishing POTS from Similar Conditions

POTS is often confused with other conditions that cause similar symptoms. Here are a few:

  1. Orthostatic Hypotension: Unlike POTS, this condition is about blood pressure dropping significantly when standing up. It can cause dizziness and fainting, just like POTS, but the causes and treatments are different.
  2. Reflex Syncope: Also known as fainting spells, this can happen due to prolonged standing or emotional stress. It’s related to POTS in that it involves the body’s response to standing, but it’s a distinct condition.
  3. Chronic Isolated Orthostatic Intolerance: This is like a milder version of POTS. It involves some of the same symptoms but without the significant increase in heart rate.

The Many Faces of POTS

Symptoms of POTS can vary a lot from person to person, but some common ones include:

  • A fast heartbeat when standing up
  • Feeling light-headed or dizzy
  • Fainting or feeling like you might faint
  • Trouble with focus and memory
  • Feeling extremely tired
  • Headaches
  • Feeling your heart pounding or fluttering (palpitations)
  • Shaky hands
  • Feeling sick to your stomach
  • Not being able to tolerate exercise like you used to

Why Does POTS Happen?

The exact cause of POTS is still a bit of a mystery. It’s thought to involve problems with the nervous system that controls automatic body functions like heart rate and blood pressure. Possible triggers include:

  • An immune system that’s attacking the body by mistake (autoimmune disorders)
  • A genetic factor that makes some people more likely to get it
  • A virus or other infection
  • A physical injury or surgery

POTS is most often seen in women, especially during their childbearing years, but it can affect anyone.

COVID-19 and Increased Risk of POTS

Recent studies have highlighted a connection between COVID-19 and Postural Tachycardia Syndrome (POTS) as well as other orthostatic intolerance syndromes1,2. Some patients who had no previous symptoms developed POTS after contracting COVID-19. Interestingly, there have also been reports of these conditions occurring in a few individuals following COVID-19 vaccination. However, a significant study involving over 280,000 vaccinated individuals and more than 12,000 COVID-19 patients found that the risk of developing POTS or similar syndromes is over five times higher in those who contracted the virus compared to those who were vaccinated3. This suggests that while there is some risk associated with the vaccine, the risk is notably higher with the actual COVID-19 infection.

How is POTS Diagnosed?

Diagnosing POTS involves looking at medical history and symptoms and doing specific tests. The tilt table test is the most common and the gold standard of diagnosing POTS, usually performed by a cardiologist (heart specialist). It involves lying on a table that tilts you at different angles while your heart rate and blood pressure are monitored. A simpler test is lying on a bed and than standing up and staying upright for a few minutes while your healthcare professional measures your blood pressure repeatedly and monitors your heart rate and your symptoms. It is important to rule out other conditions, especially lungs and heart diseases which may mimic POTS symptoms. A multidisciplinary approach is often beneficial in diagnosing POTS. This can involve cardiologists, neurologists, and other specialists who can contribute to a comprehensive evaluation.

Managing and Treating POTS

There’s no cure for postural tachycardia syndrome yet, but there are ways to manage the symptoms. Living with Postural Tachycardia Syndrome (POTS) can be challenging, but with the right management and treatment strategies, individuals can significantly improve their quality of life. Here’s an in-depth look at how POTS can be managed and treated effectively.

Natural Approaches

  1. Increased Fluid Intake: Staying well-hydrated is crucial for POTS patients. Drinking plenty of fluids helps increase blood volume, which can mitigate some of the symptoms associated with orthostatic intolerance. Aim for at least 2-3 liters of water per day, but this can vary based on individual needs and healthcare provider recommendations.
  2. Dietary Salt Intake: Increasing dietary salt can help retain water in the body, thereby increasing blood volume. This is beneficial for POTS patients. However, this approach should be discussed with a healthcare provider, especially for individuals with conditions like high blood pressure or heart disease.
  3. Compression Garments: Wearing compression stockings or abdominal binders can help reduce blood pooling in the legs and lower body, improving blood flow back to the heart. This can be particularly effective in reducing symptoms of lightheadedness and fainting.
  4. Elevating the Head of the Bed: Slightly elevating the head of the bed can reduce the morning symptoms of POTS by facilitating blood flow to the brain upon waking.
  5. Physical Activity: Regular exercise, especially aerobic and resistance training, can be beneficial. It improves cardiovascular fitness and blood flow, and can help manage symptoms. It’s important to start slowly and gradually increase the intensity under medical guidance.

Pharmacological Treatment Options

  1. Beta Blockers: These medications can be effective in reducing heart rate and improving some of the symptoms of POTS. They must be used with caution and under close supervision by a healthcare provider.
  2. Fludrocortisone: This medication helps increase blood volume by promoting sodium retention, which can be helpful in managing POTS symptoms.
  3. Midodrine: Midodrine works by constricting blood vessels and raising blood pressure, thereby helping to alleviate orthostatic intolerance symptoms.
  4. SSRIs and SNRIs: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) can be used to manage some of the symptoms associated with POTS, particularly those related to anxiety and depression.
  5. Pyridostigmine: This medication, typically used to treat myasthenia gravis, has shown promise in treating POTS by improving the communication between nerves and muscles.

Holistic and Alternative Therapies

  1. Yoga4 and Tai Chi: These practices can help improve balance, reduce stress, and increase strength and flexibility, which can be beneficial for POTS patients.
  2. Adequate Rest: Ensuring enough rest and avoiding overexertion is key. Pacing daily activities to prevent fatigue can be helpful.
  3. Stress Management: Techniques like meditation, deep breathing, and biofeedback can help manage the stress response, which can exacerbate POTS symptoms.
  4. Dietary Adjustments: Small, frequent meals can prevent the blood pressure drops that occur after eating large meals. Avoiding alcohol and caffeine can also help, as they can worsen symptoms.


POTS or postural tachycardia syndrome might sound complicated, but it’s a condition that, with understanding and management, can be approached successfully. It’s about recognizing the symptoms, seeking medical advice, and finding ways to adapt and manage. By shedding light on POTS, we hope to foster a better understanding and support for those affected by this challenging yet manageable condition.

Disclaimer: This guide is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.


  1. Blitshteyn S, Whitelaw S. Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after COVID-19 infection: a case series of 20 patients [published correction appears in Immunol Res. 2021 Apr 13;:]. Immunol Res. 2021;69(2):205-211. doi:10.1007/s12026-021-09185-5 ↩︎
  2. Shouman K, Vanichkachorn G, Cheshire WP, et al. Autonomic dysfunction following COVID-19 infection: an early experience. Clin Auton Res. 2021;31(3):385-394. doi:10.1007/s10286-021-00803-8 ↩︎
  3. Kwan AC, Ebinger JE, Wei J, et al. Apparent Risks of Postural Orthostatic Tachycardia Syndrome Diagnoses After COVID-19 Vaccination and SARS-Cov-2 Infection. Nat Cardiovasc Res. 2022;1(12):1187-1194. doi:10.1038/s44161-022-00177-8 ↩︎
  4. Freedenberg VA, Hinds PS, Friedmann E. Mindfulness-Based Stress Reduction and Group Support Decrease Stress in Adolescents with Cardiac Diagnoses: A Randomized Two-Group Study. Pediatr Cardiol. 2017;38(7):1415-1425. doi:10.1007/s00246-017-1679-5 ↩︎