Postural Orthostatic Tachycardia Syndrome: Symptoms & Treatment

Written by Medicover Team and Medically Reviewed by Dr Krishna Haskar Dhanyamraju , Neurologists

Postural orthostatic tachycardia syndrome (POTS) is a disorder of the autonomic nervous system that affects how the body regulates heart rate and blood circulation when a person stands upright. People with POTS develop an excessive increase in heart rate after standing, along with symptoms such as dizziness, palpitations, fatigue and exercise intolerance.

In adults, POTS is generally characterized by a sustained increase in heart rate of at least 30 beats per minute within 10 minutes of standing, without significant orthostatic hypotension. In adolescents aged 12 to 19 years, the required increase is generally at least 40 beats per minute. Symptoms must be chronic and other conditions that can cause a similar heart-rate response need to be excluded.

What Are the Symptoms of POTS?

POTS symptoms can vary considerably between people and are usually more noticeable when standing or remaining upright for prolonged periods. Common symptoms include:

Symptoms may become worse with prolonged standing, heat, dehydration, illness, alcohol or physical exertion. Some people experience significant worsening of symptoms after increased activity.

What Causes POTS?

The exact cause of POTS is not fully understood. It is considered a multifactorial disorder involving abnormalities in the regulation of blood flow, heart rate and the autonomic nervous system.

POTS may develop after or alongside conditions or events such as:

In some people, no clear triggering event or underlying cause can be identified. POTS is also associated with several other conditions, so evaluation may be needed to identify contributing or coexisting disorders.

When Should You See a Doctor for POTS?

Consult a doctor if you repeatedly experience dizziness, rapid heartbeat, weakness or other symptoms after standing, particularly if these symptoms interfere with daily activities.

Medical evaluation is especially important if you experience:

A primary care physician may begin the evaluation and refer you to a cardiologist, neurologist or specialist experienced in autonomic disorders when appropriate. Physical therapists or rehabilitation specialists may also help with an individualized exercise program.

Seek urgent medical attention for severe chest pain, severe breathing difficulty, prolonged loss of consciousness or other potentially serious symptoms.

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How Is POTS Diagnosed?

There is no single blood test that confirms POTS. Diagnosis is based on symptoms, changes in heart rate and blood pressure with standing, and exclusion of other conditions that can cause similar symptoms.

Medical History and Physical Examination

The doctor will ask about symptoms, when they occur, possible triggers, medications, fluid and dietary intake, exercise tolerance and any relevant medical conditions. Heart rate and blood pressure are measured while lying down and after standing.

10-Minute Standing Test

Heart rate and blood pressure may be monitored while the patient rests lying down and then stands for up to 10 minutes. A sustained heart-rate increase of at least 30 beats per minute in adults, without significant orthostatic hypotension, can support the diagnosis when the other diagnostic criteria are met.

Tilt-Table Test

A head-up tilt-table test may be used when the diagnosis is uncertain or when more detailed assessment of the body's response to upright posture is needed. During the test, heart rate and blood pressure are monitored while the patient is gradually moved from a lying position to an upright position.

Additional Tests

Additional investigations may be performed to identify other causes of rapid heart rate or dizziness. Depending on the person's symptoms, these may include:

Conditions such as anemia, dehydration, thyroid disease, infection, certain medications and prolonged physical deconditioning may need to be considered because they can produce similar symptoms.

What Are the Treatment Options for POTS?

There is no single treatment that works for everyone with POTS. Management is individualized according to symptoms, underlying conditions and the person's response to treatment. Treatment commonly begins with lifestyle measures and physical reconditioning, with medications considered when symptoms remain troublesome.

Fluids and Salt

Increasing fluid intake and, when medically appropriate, increasing dietary sodium can help expand blood volume and reduce symptoms in some people. The appropriate amount should be discussed with a healthcare professional, particularly in people with kidney, heart or blood-pressure conditions.

Exercise and Physical Reconditioning

A structured, gradual exercise program can improve physical conditioning and may reduce POTS symptoms. Exercise is usually increased progressively, beginning with activities that are better tolerated, such as recumbent or semi-recumbent exercise, before progressing toward more upright activities.

Compression Garments

Compression garments may help reduce excessive blood pooling in the legs and improve circulation when standing. Some patients benefit from garments that provide abdominal and lower-body compression.

Medication

Medication may be considered when lifestyle measures do not provide adequate relief. Depending on the patient's symptoms and medical history, doctors may use medicines such as beta-blockers, midodrine, fludrocortisone, pyridostigmine or other medications in selected cases.

Medication choices should be individualized because different forms of POTS and coexisting medical conditions can require different approaches. Many medications used for POTS are used off-label, and there is no single medication that is effective for every patient.

Multidisciplinary Care

Some people benefit from care involving several specialists, such as cardiology, neurology, autonomic specialists, physical therapy, rehabilitation medicine and other professionals depending on their symptoms and associated conditions.

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What Are the Risk Factors for POTS?

Certain factors may be associated with an increased likelihood of developing POTS, although having one of these factors does not mean that a person will develop the condition.

What Is the Outlook for People With POTS?

POTS can significantly affect daily activities, exercise, education and work, but symptoms vary widely between individuals. Some people experience substantial improvement over time, while others have persistent or fluctuating symptoms.

With an individualized combination of lifestyle changes, physical conditioning, symptom management and medications when needed, many people are able to improve their daily functioning and quality of life.

What Can Help Manage POTS Symptoms?

Several everyday measures may help reduce symptom flare-ups:

Because POTS can have different underlying mechanisms and may occur alongside other conditions, management should be personalized rather than based on a single treatment approach.