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).

Some sources estimate that as many as 1 million people in the United States have POTS. 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. Older 2008 research estimates that 25 percent of people with POTS have symptoms that are so severe it impairs their ability to perform household tasks or participate in the workforce.

Keep reading to learn more about the symptoms, why POTS happens, and how to cope.

People who don’t have POTS can switch between 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 pulse rate may increase for 15 to 20 seconds after standing, but after a few minutes, it should calm down.

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 beats per minute (bpm) higher than usual. This can make you feel like you need to sit or lie back down.

Blood may also pool in your lower legs and feet, giving them a swollen or purple appearance, until you sit down again.

Other symptoms of POTS include:

  • headache
  • blurred vision
  • heart palpitations
  • disturbed concentration
  • gastrointestinal issues (nausea, cramps, bloating, etc.)
  • weakness
  • anxiety
  • difficulty sleeping
  • cold or pain in the arms or legs

There are a few different subtypes of POTS. While all of these subtypes have an overarching symptom of tachycardia (which is a term for a heart rate faster than 100 bpm), each subtype can have different effects on the body.

Neuropathic POTS

This subtype is associated with damage to small nerves that regulate the constriction of blood vessels in the legs and abdomen. This may increase the symptom of limb discoloration when standing up.

Hyperadrenergic POTS

This type of POTS is associated with elevated levels of norepinephrine, which is a stress hormone. The symptoms of hyperadrenergic POTS can include increased anxiety, tremors, and heart palpitations.

Hypovolemic POTS

People with the hypovolemic subtype of POTS typically have decreased blood levels.

Autoimmune POTS

Less of an actual subtype and more of a hypothesis, autoimmune POTS is thought to occasionally be connected to other autoimmune conditions, especially Hashimoto’s thyroiditis. Since many of the biomarkers of autoimmune disease match those seen in people with POTS, researchers believe there might be a connection.

Deconditioning POTS

Another subtype that’s more of a hypothesis, researchers believe certain instances of POTS could be related to deconditioning — although it’s still unclear whether POTS causes the deconditioning, or the deconditioning causes POTS. Deconditioning is simply defined as physiological changes that occur after a prolonged period of inactivity, such as bed rest.

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.

Although POTS can affect anyone of any age, about 80 percent of cases are diagnosed in women ages 15 to 50.

Sometimes, POTS symptoms may be triggered by life events, such as:

These events may change the way that the ANS behaves for a period of time.

If you think you are experiencing symptoms of POTS, talk with a doctor. They will most likely ask detailed questions about:

  • what your daily activities are
  • how long the symptoms have been occurring
  • how much the symptoms affect you

You should also talk with your doctor about any medications you take. Certain medications, such as some drugs for blood pressure, depression, and anxiety, can interfere with your ANS and blood pressure control.

Testing

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.

Your 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.

Seeing a specialist

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 for postural orthostatic tachycardia syndrome. It may take some trial and error to determine which combination of medication and lifestyle changes helps you the best.

Medications

There are a variety of medications that seem to work in the short term for POTS, although it still remains uncertain if any of them work in the long term. Certain medications include:

Sometimes, your doctor may also suggest salt tablets as part of a prescription treatment regimen. Intravenous (IV) saline solutions are another short-term treatment.

Lifestyle changes

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.

Certain recommended lifestyle tips include:

  • 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 a regular, structured exercise routine if possible.
  • Make it a point to stay hydrated.

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.

If you can, 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 80 percent of treated postural orthostatic tachycardia syndrome cases, symptoms improve and allow a person to function better.

While it’s possible for symptoms to completely disappear, it’s also possible that symptoms can come and go for years. Working with your doctor on a personalized treatment plan that includes lifestyle changes can increase the chances that your symptoms will ease.

If you believe you may be dealing with POTS symptoms, talk with a doctor as soon as you can. POTS can occasionally be misdiagnosed (for example, as anxiety), so make sure you keep a detailed record of your symptoms, and always get a second opinion if you think it could help.