Postural Orthostatic Tachycardia Syndrome (POTS) and Your Heart: What You Need to Know

POTS causes your heart rate to increase by more than 30 beats per minute or beat faster than 120 beats per minute with changes in position. The result can make you feel like you’re exerting yourself, even when you’re just standing in place.

An increased heart rate can cause palpitations as if your heart is fluttering. You may even feel like you’re going to faint because your heart is beating so fast that it can’t get blood to other parts of your body or because your blood pressure goes down.

Other heart-related symptoms you may experience due to POTS include:

• a bluish tint to your extremities due to poor oxygen
• chest pain
• dyspnea, or exercise intolerance

If these symptoms sound familiar, it’s because they can mimic some conditions related to heart disease. For example, a heart attack can cause chest pain, shortness of breath, and fainting. Heart failure can cause arm and leg swelling, shortness of breath, and a bluish tint to your extremities.

While these symptoms can occur during an episode of orthostatic intolerance related to POTS, they don’t usually last long. Lying down can help your symptoms resolve. If you were experiencing a heart attack or had heart failure, your symptoms would most likely continue.

Because the symptoms can be similar, doctors will often test for issues with your heart before giving you a diagnosis of POTS. “We make sure that the heart itself is structurally normal by performing an echocardiogram, which is an ultrasound of the heart,” says Dr. Brent P. Goodman, assistant professor and neurologist at the Mayo Clinic in Phoenix, Arizona.

Dr. Goodman says that regular testing for POTS includes other heart tests. “We will make sure that the intrinsic electrical system of the heart is functioning normally by performing an electrocardiogram, and sometimes with a longer recording called a Holter monitor.” A doctor may also perform a tilt-table test to see how your heart responds.

While POTS and heart failure may share similar symptoms, Dr. Goodman says there’s no causal link. “POTS is not expected to contribute to or cause heart failure or other forms of heart disease.”

But that doesn’t mean that people with POTS shouldn’t be concerned about their heart health. “Of course, the fact that someone has POTS does not mean that they cannot develop heart disease due to other things that they may have or develop in the future.” Dr. Goodman cites diabetes and hyperlipidemia as two such conditions of concern.

There are a lot of medical conditions that can cause symptoms that are similar to POTS. For example, anemia, anxiety, and (more rarely) pheochromocytoma can all cause increased heart rates like POTS can.

The takeaway is that if you experience a racing heart and dizziness upon standing, don’t assume your symptoms are POTS and refrain from getting care. It’s important that a doctor rules out other possible causes (such as heart disease) so they can give you a diagnosis and help you manage your condition.

If your symptoms suddenly get much worse or are accompanied by chest pain, get immediate medical attention.

POTS also shares many symptoms with post-acute sequelae of COVID-19 (PASC), also known as long COVID. It’s unclear whether COVID can cause POTS, but research is ongoing. Talk with a doctor if you’re experiencing symptoms of POTS after having COVID-19.

POTS isn’t easy to treat. People with POTS often have a wide range of symptoms, and doctors don’t know enough about its causes to identify potential cures for the condition. As a result, POTS treatments are usually to address the symptoms you have.

A doctor may prescribe medications such as beta-blockers to lower your heart rate.

They may also prescribe medication to help keep up volume balance and lower the effects on your heart. Specific examples include:

• clonidine
• midodrine
• pyridostigmine
• fludrocortisone

Home management

You can take several actions on your own to help manage POTS. Examples of at-home management tips for POTS include:

• Drink enough water and fluids daily to stay hydrated.
• Consume an appropriate amount of sodium daily to keep up your electrolyte balance.
• Rise slowly when you move from a sitting to a standing position.
• Wear compression stockings to help blood return to your heart. This can help you avoid fainting.

Overall wellness maintenance, such as getting enough rest and eating a healthy diet, can also help lower POTS symptoms. So can taking measures to lower stress whenever possible.

Exercise can greatly benefit your heart health if you have POTS. But getting regular exercise can be a challenge for some people with POTS.

Keep in mind that you don’t need to be in an upright position for all exercise. Other options include:

• rowing machines
• recumbent bicycles
• swimming

Other ways to improve heart health include refraining from smoking and eating a low-fat diet. Using this dietary approach can help you keep up a moderate weight.

The following are some frequently asked questions related to POTS, the heart, and heart disease.

Is POTS a type of heart disease?

Doctors call POTS a “cardiovascular autonomic disorder.” This means you experience some change in your autonomic nervous system (which controls your heart rate) that causes your heart to speed up when it shouldn’t. While POTS does affect your heart, it’s not a form of heart disease.

Is POTS life threatening?

POTS can be very scary, especially if you faint upon standing (about 30% to 50% of people with POTS do). But the condition isn’t usually life threatening, although it can be distressing. About 50% of people with POTS no longer experience symptoms within 1 to 3 years of receiving their diagnosis.

Typically, the most significant risk to a person with POTS is the potential to fall and injure themselves during an episode of orthostatic intolerance.

Are beta-blockers safe for your heart?

A doctor may prescribe beta-blockers if you have POTS. Beta-blockers lower the effects of beta stimulation on the heart. Most noticeably, they decrease your heart rate, so your heart uses less oxygen and can pump more effectively.

Beta-blockers are generally safe and effective. They’re also prescribed by doctors to treat heart failure. They may help slow the progression of heart disease, but they won’t reverse existing heart failure.

But beta-blockers aren’t good for acute, decompensated heart failure. This is a time when a person’s heart failure symptoms suddenly get worse, and they usually experience significant problems breathing.

POTS is a condition that causes your heart to beat more rapidly. But POTS isn’t a heart disease and isn’t likely to cause heart failure.

The fact that POTS isn’t life threatening doesn’t mean the condition isn’t debilitating for those who experience it. “POTS is an extremely common condition that predominantly affects women, and it should be prioritized,” stresses Dr. Goodman.

Talk with a doctor if you have POTS symptoms to determine how to lower your risk of falling and of acute episodes of POTS.