Postural Orthostatic Tachycardia Syndrome
Also known as: POTS, Postural tachycardia syndrome
Postural orthostatic tachycardia syndrome (POTS) is a disorder of the autonomic nervous system in which standing up causes an abnormally large rise in heart rate, typically by 30 beats per minute or more in adults, without a drop in blood pressure. The result is lightheadedness, a racing heart, fatigue, brain fog, and sometimes fainting when upright, with relief on lying down. POTS most often affects young women and can follow a viral illness, pregnancy, surgery, or a period of prolonged bed rest; it has become more widely recognized since being linked to long COVID. Although it can be debilitating, POTS is not life-threatening, and a combination of fluid and salt, graded exercise, compression, and medication helps most people improve.
At a Glance
- Common symptoms
- Rapid heartbeat, palpitations, or pounding on standing, Lightheadedness, dizziness, or near-fainting when upright, Fatigue and exercise intolerance
- Main treatments
- Increased fluid and salt intake (under medical guidance) to expand blood volume, Compression garments for the legs and abdomen to reduce blood pooling, A structured, graded exercise program starting with recumbent exercise (rowing, recumbent cycling, swimming)
- Category
- Cardiovascular · Uncommon but increasingly recognized, especially among young women and following viral infections
- See a doctor if
- Repeated dizziness, racing heart, or near-fainting when you stand
Symptoms
Causes
- Autonomic nervous system dysfunction affecting blood vessel constriction
- Low blood volume (hypovolemia)
- Excessive sympathetic ('fight or flight') activation, sometimes with high norepinephrine levels
- Autoimmune mechanisms, including antibodies against receptors that regulate heart rate and vessels
- Deconditioning after illness, surgery, or bed rest
- Triggers such as viral infections (including COVID-19), pregnancy, trauma, or concussion
Risk Factors
- Female sex, particularly between the teens and early 40s
- Recent viral illness or long COVID
- Hypermobile Ehlers-Danlos syndrome or joint hypermobility
- Autoimmune conditions
- Prolonged bed rest or inactivity
- Family history of POTS or autonomic disorders
Diagnosis
- Active stand test measuring heart rate and blood pressure lying and then standing over 10 minutes
- Tilt-table testing in a specialized clinic
- ECG and sometimes echocardiogram or heart monitoring to exclude arrhythmias and structural heart disease
- Blood tests to rule out anemia, thyroid disease, dehydration, and adrenal problems
- Further autonomic testing in some cases
Treatment
- Increased fluid and salt intake (under medical guidance) to expand blood volume
- Compression garments for the legs and abdomen to reduce blood pooling
- A structured, graded exercise program starting with recumbent exercise (rowing, recumbent cycling, swimming)
- Medications such as beta-blockers, ivabradine, fludrocortisone, midodrine, or pyridostigmine depending on the subtype
- Treatment of associated conditions such as hypermobility or autoimmune disease
- Supportive: raising the head of the bed, avoiding prolonged standing and heat, and eating smaller, more frequent meals
- Supportive: counter-maneuvers such as crossing the legs or tensing muscles when symptoms start
Prevention
- Stay well hydrated, especially in hot weather and during illness
- Avoid prolonged bed rest where possible; keep moving during recovery from illness
- Rise slowly from lying or sitting
- Maintain regular physical conditioning
- Manage triggers such as large carbohydrate-heavy meals and alcohol
When to See a Doctor
- Repeated dizziness, racing heart, or near-fainting when you stand
- Fainting episodes, especially with injury
- Symptoms limiting your ability to work, study, or exercise
- Chest pain, shortness of breath, or palpitations at rest (seek urgent care)
- New symptoms after a viral illness that are not improving over weeks
Frequently Asked Questions
Related Conditions
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