Postural orthostatic tachycardia syndrome (POTS) is a term used to describe a group of neurological conditions that have similar symptoms. People with POTS feel fatigued or dizzy when they stand up from a sitting position. Most people diagnosed with POTS experience heart palpitations or a significantly increased heart rate when they stand up.
When you have these symptoms after standing upright, it’s known as orthostatic intolerance (OI). It’s estimated that at least 500,000 people in the United States experience OI, the main symptom of POTS.
Some sources say the number of people with POTS is much higher, estimating that as many as 3 million adolescents and adults experience it. Some people have symptoms that completely disappear within 2 to 5 years, and others have symptoms that come and go over their lifetime.
People with POTS also experience different degrees of symptom severity. About 25 percent of them have symptoms that are so severe, it impairs their ability to perform household tasks or to participate in the workforce.
Keep reading to learn more about the symptoms, why POTS happens, and how to cope.
What are the symptoms?
People who don’t have POTS can switch among reclining, sitting, and standing without much thought. The autonomic nervous system (ANS) takes over and manages how gravity affects the body according to its position, including the mechanism that manages balance and blood flow. Your heart rate should adjust to be 10 or 15 beats per minute (bpm) higher when you’re standing than when you’re sitting, and your blood pressure should decrease only slightly.
If you have POTS, though, your body doesn’t send the right signals to your brain and heart when you change position. This results in an increased heart rate of up to 30 bpm higher than usual. This can make you feel like you need to sit or lie back down.
Flushing can also occur due to the activation of certain chemicals by immune cells in your body. This can result in breathlessness, headache, and feeling lightheaded. This activation can also cause nausea, vomiting and diarrhea. Blood may also pool in your lower legs and feet, giving them a swollen or purple appearance.
You may also experience:
What causes POTS and who’s at risk?
The cause of POTS isn’t always clear. That’s because the condition doesn’t trace back to one root cause for every person that has it. There is some evidence that certain genes may contribute to POTS development. Research by the Mayo Clinic suggests that in half of POTS cases, the cause might be autoimmune related.
It does seem that POTS symptoms are often triggered by life events, such as:
These events may change the way that the ANS behaves for a period of time.
Although POTS can affect anyone of any age, about 80 percent of cases are diagnosed in women ages 15 to 50 years.
How it’s diagnosed
If you have POTS symptoms, see your doctor. They will ask detailed questions about:
- what your daily activities are
- how long the symptoms have been occurring
- how much your symptoms affect you
You should also talk to your doctor about any medications that you take. Certain medications, such as some drugs for blood pressure, depression, and anxiety, can interfere with your ANS and blood pressure control.
If your doctor suspects POTS, they’ll observe you sitting, lying down, and standing. They will record your pulse and blood pressure after every position change and note what symptoms you experience.
You doctor may also recommend a tilt table test. As the name suggests, this test involves being fastened to a table while it is moved to different angles and positions. Your doctor will also monitor your vital signs during this test.
If further evaluation is needed, your doctor may refer you to a neurologist, cardiologist, or specialist that focuses on the connection between the brain and the heart. POTS is sometimes misdiagnosed as an anxiety or panic disorder, so it’s important that your doctor understand your symptoms.
If you’re diagnosed with POTS, your doctor will work with you to develop an individualized treatment plan.
There isn’t a one-size-fits-all treatment or medication. It may take some trial and error to determine which medication can best relieve your symptoms.
Fludrocortisone (Florinef) and midodrine (ProAmatine) are commonly prescribed for POTS management. Some people have also used beta-blockers and SSRIs to treat POTS. Sometimes, your doctor may also suggest salt tablets as part of a prescription treatment regimen.
Changing your diet is often part of treatment for POTS. By increasing your water intake and adding more sodium to what you eat, you can increase your blood volume. This can lessen the severity of your symptoms.
However, most people aren’t advised to eat a high-sodium diet, so talk with your doctor about how much sodium you need.
Try these lifestyle tips:
- Add an extra dash of table salt to your food.
- Snack on pretzels, olives, and salted nuts.
- Eat smaller meals throughout the day and take snack breaks to help maintain hydration and energy.
- Get enough regular, quality sleep.
- Participate in reclined aerobic exercise, such as biking or rowing.
- Drink 16 ounces of water before standing up.
Living with POTS
If you’re living with POTS, one of the best things you can do is identify the trigger points for your symptoms. Keep a journal of your symptoms. It may help you better identify things that could be related to your symptoms.
For example, you may tend to have symptoms before your period. Maybe dehydration aggravates your symptoms. Perhaps warmer temperatures make you more likely to feel dizzy or anxious when you stand up.
Educate yourself on what your body needs. Then you can adjust your behavior appropriately and treat your symptoms better. You should try to limit periods of extended standing when you know that your POTS may be triggered, and consider carrying a bottle of water with you at all times.
You may also want to speak with a counselor or other mental health professional about how your symptoms impact your life. If you’ve been diagnosed with POTS, it’s important to know that your symptoms are real — you aren’t imagining them — and that you’re not alone.
In up to 90 percent of treated cases, POTS symptoms become much more manageable over time. Sometimes, symptoms even disappear over several years. Men who have POTS are more likely to make a full recovery compared to women. Although there is no cure for POTS, treatments are advancing through research.