What Is Postural Orthostatic Tachycardia Syndrome?
Postural orthostatic tachycardia syndrome (POTS) is a disorder in which most of your blood stays in your lower body when you stand up, and in response, your heart rate jumps.
Your blood usually flows at a steady rate whether you're sitting, standing, lying down, or hanging upside-down from a tree branch in the backyard. But if that rate changes when you change positions, that's a condition called orthostatic intolerance. It's the most common symptom of POTS. It can make you feel dizzy, lightheaded, or faint.
It affects about 1-3 million people in the U.S. Most people get better, but some people have symptoms that come and go over a number of years. About 25% of people with POTS have symptoms that make it difficult to work.
POTS can throw your whole body off-balance. You might have:
- Dizziness or fainting
- Blurry vision
- Belly pain
- Diarrhea or constipation
- Severe sweating
- Brain fog
- Extreme fatigue
- Higher or lower blood pressure
- Faster or slower heartbeat
- Palpitations, a feeling that your heart is pounding or fluttering
- Chest pain
- Feeling hot or cold
- Feeling anxious, nervous, or jittery
- Shaking or tremors
- Headaches, body aches, or neck pain
- Unusual color in hands and feet. Your face will be pale, and your hands and feet will be purple if they are lower than your heart
You might be more likely to notice these when you're in the shower, standing in line, or feeling stressed. You also may have POTS symptoms after you eat because your intestines need more blood for digestion. Other triggers for POTS symptoms include hard exercise, being sick with a cold or flu, and having your period.
Types of POTS
POTS can happen for different reasons. You could have more than one kind. Some of the most common are:
- Neuropathic POTS. You have damage to small fiber nerves that manage blood flow in your limbs and abdomen.
- Hyperadrenergic POTS. You have higher levels of the stress hormone norepinephrine.
- Hypovolemic POTS. You have unusually low blood levels.
If your POTS symptoms are the result of another condition you have, such as an autoimmune disorder, that's sometimes called secondary POTS.
Scientists aren't sure what causes POTS.
Some researchers believe it's an autoimmune disorder, based on the presence of certain antibodies in people with POTS. When you have an autoimmune disorder, your body's defense system attacks healthy tissue for unknown reasons.
POTS Risk Factors
People assigned female at birth aged between 15 and 50 years are more likely to have POTS. It can run in families, but researchers haven't identified a single gene that might be linked to the condition.
Several diseases and conditions seem to make you more likely to have POTS. These include:
- Anemia (when you don't have enough red blood cells)
- Autoimmune diseases, like Sjogren's syndrome or lupus
- Chronic fatigue syndrome
- Diabetes and prediabetes
- Ehlers-Danlos, a muscle and joint condition
- Illnesses like mononucleosis, Lyme disease, or hepatitis C
- Multiple sclerosis
- Click-murmur syndrome (also called mitral valve prolapse)
- Epstein Barr virus
- SARS-CoV2, the virus that causes COVID
It can also happen after a serious infection, pregnancy, or a head injury. Other triggers include the onset of puberty, major surgery, viral illness, or bodily trauma.
If you have POTS, your doctor might think an anxiety or panic disorder is a factor. But some symptoms of anxiety and panic overlap with POTS symptoms. Researchers are still investigating what role anxiety plays.
With such different symptoms, POTS can be hard to diagnose.
This may be the best way to diagnose POTS.
Your doctor will ask you to lie flat on a table and strap you in so you won't fall when it tilts. The table slowly moves your body upright to simulate standing up. Your doctor will watch for changes in your heart rate.
Some people who have POTS may faint during this test. It's important to work with a doctor who's very familiar with the condition. This might be a heart doctor (cardiologist) or a doctor who specializes in problems with your nerves and muscles (neuromuscular specialist).
Your doctor might also order other tests, including:
- Urine tests to measure your sodium levels and rule out other causes of your symptoms
- Blood tests to check your kidneys, liver, and thyroid gland and to rule out other causes
- EKG and echocardiogram to see how well your heart is working
- Quantitative sudomotor axon reflex test to test the nerves that control sweating
- Valsalva maneuver to check the nerves that control your heart; you breathe out strongly through your mouth while holding your nose closed
- Autonomic breathing test to measure your blood flow and pressure during exercise
- Nerve biopsy to take a tiny sample of nerve fibers for analysis under a microscope. This is a minimally invasive procedure that goes about one-eighth of an inch into your skin.
There's no cure for POTS, but treatment can help with your symptoms.
- Medication. Your doctor may prescribe drugs such as fludrocortisone (along with more salt and water), midodrine, phenylephrine, or a type of medicine called a beta-blocker to help with blood flow. Selective serotonin reuptake inhibitors are a type of antidepressant that can modify your brain's response to low blood pressure signals and help with depression that can occur with POTS. Other antidepressants, serotonin and norepinephrine reuptake inhibitors, are also sometimes prescribed, but certain ones are not recommended when you have POTS. You might also take antianxiety medication.
- Compression stockings. These help push the blood up from your legs to your heart. You'll want ones that provide at least 30-40 minutes of compression and go all the way up to your waist or at least up to your thighs. Your doctor can prescribe a pair.
- Diet. Salt and water are key. They keep fluids in your body and raise the amount of blood in your body. Think pickles, olives, nuts, and salted broths. Eat smaller meals more often with a healthy balance of protein, vegetables, fruits, and dairy. Drink 2-2.5 liters of fluids—water is the best choice—each day. You may be able to reduce your symptoms by eating a diet high in fiber and complex carbohydrates. This helps you avoid blood sugar spikes.
- Exercise. POTS can make it hard to be active, but even light exercise such as walking or simple yoga can help with blood flow and keep your heart healthy. You also can try isometric exercises, which means working your muscles without actually moving your body. You can do them while you're lying down or seated.
- Lifestyle. If you get tired easily, you may not always have the energy to take care of yourself.
- Sleep. You might raise the head of your bed to make it easier to stand up after lying down. Make sure the temperature in your bedroom is ideal for sleeping. Try to go to bed at the same time each night and avoid napping during the day. Watching television or using your phone, tablet, or computer while in bed can interfere with your sleep.
- Communication. POTS can make simple activities a bit harder and that can be frustrating and stressful. A support group or therapist may help you manage the emotional issues the condition can cause.
When you know what your triggers are, you can help manage your POTS by avoiding them. Keeping track of your blood pressure and pulse can help identify your triggers. Take them at the same time each day and log them. This information may also help your doctor tweak your treatment. Other steps you can take include:
- Keep an even temperature. Use air-conditioning or handheld fans to avoid overheating. Make your showers lukewarm instead of hot.
- Don't stand for long periods. If you have to wait in a line, shift your weight from foot to foot, and squeeze and flex your muscles.
- Avoid alcohol, which can dehydrate you.
When you have POTS, most of your blood stays in your lower body when you stand up, and in response, your heart rate jumps. This can lead to dizziness, fainting, and other symptoms. Researchers aren't sure what causes it; it might be an autoimmune disorder. Many conditions, including pregnancy, viral illnesses, and diabetes can raise your risk. There's no cure for POTS, but medication can help. You can also change your diet and exercise routine to help manage symptoms.
Is POTS a serious condition?
POTS can have a major impact on your life, but it's not life-threatening. The biggest risk is that you'll injure yourself in a fall. Most people with POTS improve, though you may still have symptoms on and off.
What does POTS do to you?
The symptoms of POTS vary from person to person. Because most of your blood stays in your lower body when you stand up, your heart beats faster trying to send blood to your brain. You might feel dizzy, nauseated, or too hot or cold. Some people with POTS are very tired and have cognitive problems, called "brain fog." Because the symptoms are so varied and overlap with a lot of other conditions, POTS can be hard to diagnose.