Postural orthostatic tachycardia syndrome (POTS)

What are the symptoms of postural orthostatic tachycardia syndrome?

Postural orthostatic tachycardia syndrome (POTS) causes your heart rate to increase faster than normal after getting up from sitting or lying down. It can also lead blood pressure to fall. POTS has a range of possible symptoms that vary from person to person, including:

• Fatigue
• Dizziness or feeling light-headed
• Fainting (syncope)
• Palpitations
• Breathlessness
• Chest pain (angina)

People with POTS can also suffer with other symptoms related to dysfunction of the autonomic nervous system:

• Irritable bowel syndrome
• Headaches and migraines
• Disturbed sleep patterns
• Forgetfulness or trouble focusing
• Shaking or excessive sweating
• Feeling anxious or nervous

What is postural orthostatic tachycardia syndrome?

Postural orthostatic tachycardia syndrome (POTS) is a blood circulation disorder that causes your heart rate to increase very quickly when you move from sitting or lying down to standing up, and blood pressure to fall. 

Postural: The position of the body

Orthostatic: Related to standing upright

Tachycardia: A heart rate over 100 beats per minute

Syndrome: A group of symptoms that occur together

POTS impacts the autonomic nervous system which regulates functions in the body that people don't consciously control, such as blood pressure, heart rate and body temperature. The autonomic nervous system, when functioning properly, keeps blood flowing around your body at a healthy pace, regardless of the position your body is in. 

When we sit or lie down, blood pools in the lower half of the body and causes a natural drop in blood pressure. If you have POTS, your nervous system does not automatically respond when you stand up. To compensate, your heart rate increases in an attempt to pump blood to the upper half of the body. This can cause symptoms such as dizziness and feeling faint or palpitations.

Some people only experience mild symptoms from POTS, while others can find the condition seriously impacts their quality of life and the ability to complete everyday tasks.

Medical conditions similar to POTS

Many conditions share similar symptoms to POTS. 

Inappropriate sinus tachycardia (IST) is a related condition that’s also due to autonomic nervous system dysfunction. In IST, the resting heart rate consistently sits above 100 beats per minute and increases further with exercise. This causes persistent palpitations. IST can often be treated through medication.

Vasovagal syncope, or frequent fainting, is also related to POTS and due to malfunction of the autonomic nervous system. The predominant symptom in vasovagal syncope is loss of consciousness or profound dizzy spells. Faints commonly occur in certain circumstances such as: 

• Hot and crowded environments
• Standing or sitting for too long
• Stressful situations
• After eating a large meal
• After consuming too much alcohol
• When going to the toilet, particularly at night time

What can cause symptoms of POTS to worsen?

People may find that their POTS symptoms get worse in different situations:

• Being stood up for a long time
• Not eating enough or drinking enough fluids
• Increased body temperature, such as after a hot bath or shower, or spending time outside on a hot day
• Participating in strenuous exercise
• Feeling unwell from a cold or an infection

Postural orthostatic tachycardia syndrome treatment options

Unfortunately, there isn't a cure for POTS, but our consultants may recommend a range of treatments to help manage the symptoms. 

Treatment options for POTS will vary on an individual basis, as the severity of your symptoms and any underlying conditions will determine what course of action best suits your needs.

Lifestyle changes

Making some small lifestyle changes can dramatically improve your POTS. 

• Drink more water: Drinking between 2-3 litres of water each day will improve your blood volume and help oxygen reach the heart faster.
• Add more salt to your diet: Studies have shown that increasing your sodium intake can also help to increase blood volume which is often low in people with POTS. Drinking Lucozade or adding electrolyte powders to food or drinks is often healthier than eating table salt.
• Cut down on alcohol and caffeine: Certain foods and drinks can aggravate symptoms of POTS in some people.

Our POTS specialists can help you find the most effective way to alter your diet that is best suited to your condition.

Physical exercise

Maintaining an active lifestyle and regular physical activity is one of the most effective ways to manage POTS. However, it should be noted that suddenly changing your physical activity routine could cause your symptoms to worsen, so this should be done gradually over time. 

We can help you come up with an exercise plan that is tailored to your needs and your condition.

Some of the most effective types of physical activity for alleviating symptoms of POTS are gentle exercises such as walking, swimming, water aerobics or yoga, which can help to circulate the blood in your body without needing strenuous exercise. These forms of exercise will also help to strengthen your core and leg muscles, which in turn will help boost your blood flow.

Medication

As symptoms of POTS can vary from person to person, there is no single medication that is effective for treatment in all people. Our specialist cardiologists will assess your condition and work out the most effective medication to take to control your symptoms. 

Some of the most commonly prescribed medications for the treatment of POTS are:

• Fludrocortisone: This medication is commonly prescribed to help return the heart rate to a normal pace and reduce the frequency of abnormal heart rhythms by helping the kidneys retain sodium.
• Midodrine: This is used to increase and maintain blood pressure by causing the blood vessels to narrow.
• Beta blockers: By slowing the heart rate down and reducing blood pressure, beta blockers can help reduce upright tachycardia.