Symptoms of postural orthostatic tachycardia syndrome (POTS)

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Symptoms of POTS can range from mild to severe. They can be different each day, and they may develop suddenly or more slowly over a period.

The most common symptom is orthostatic intolerance. This means that there is a reduced volume of blood that returns to the heart when standing up from lying down. This can cause lightheadedness and fainting.

Other symptoms that may occur when a person stands up include:

• dizziness
• heart palpitations
• shortness of breath
• sweating
• shaking
• chest pain

Other symptoms that may occur include:

• digestion problems, such as:
  • vomiting
  • feeling sick
  • constipation
  • diarrhea
  • bloating
  • stomach pain
• blurred vision or tunnel vision
• headaches
• fatigue
• weakness
• memory problems or brain fog

Learn more about POTS.

A person may find that their POTS symptoms are worse in the morning.

Several other factors that can make POTS symptoms worse include:

• feeling hot
• not drinking enough fluids
• eating certain foods, such as white bread and other refined carbohydrates
• exercising
• too much rest
• menstruation
• drinking alcohol

It is best for a person to contact a doctor if they notice that any specific factors or situations appear to worsen their symptoms.

When a person lies down, the body does not have to work as hard to distribute blood to the heart and brain.

This is why some people may experience fainting or lightheadedness as a result of orthostatic intolerance. When the body is unable to get enough blood to the heart and brain quickly enough, lying down can cause a reduction of symptoms.

To help manage the symptoms of POTS, there are a number of steps a person can take. These can include:

• drinking plenty of fluids
• gently exercising
• sleeping with the head of the bed raised to avoid being completely flat
• sitting at the edge of the bed before getting up so that the body can acclimate to the change in position
• wearing support tights to help the flow of blood
• standing or sitting up slowly after lying down
• avoiding excessive caffeine or alcohol consumption
• drinking two glasses of water before standing
• increasing salt intake, only if a doctor advises

If these steps do not help relieve the symptoms of POTS, a doctor may prescribe medications. These can include:

• fludrocortisone, to retain salt and increase blood volume
• midodrine, to increase blood volume and narrow blood vessels
• beta-blockers, to slow the heart rate

POTS typically affects people assigned female at birth between the ages of 15–50 years. However, POTS can affect anybody, and it may develop at any age.

Some research suggests that POTS can develop after a person experiences the following:

• an infection
• pregnancy
• surgery
• a traumatic event
• certain vaccinations

There are several steps a doctor may take to diagnose POTS. They may first begin by performing a physical examination, taking a full medical history, and asking questions about a person’s symptoms.

Then, they may order various tests, which can include:

• blood pressure and heart rate tests, such as:
  • electrocardiogram (ECG)
  • echocardiogram
  • 24-hour monitoring
• blood and urine tests
• tilt table test
• active stand test, which involves measuring the blood pressure and heart rate after standing up

Diagnosing POTS can be difficult, as the presenting symptoms can be similar to several other conditions. Some of the diagnostic criteria for POTS can include:

• POTS symptoms when standing for a period of at least 3 months
• a continual heart rate of more than 30 beats per minute within 10 minutes of standing, or 40 beats per minute for people between 12–19 years old
• typically no drop in blood pressure when a person stands

If a person is experiencing symptoms and believes they may have POTS, it is best that they contact a doctor.

The doctor will be able to order tests to confirm the diagnosis and rule out other possible causes. They will also be able to advise on a suitable treatment plan and help the individual find ways to manage their symptoms.

Here are some more frequently asked questions about POTS.

How do you know if you have POTS?

If a person experiences certain symptoms, such as dizziness, heart palpitations, or feeling faint after standing, which then get better after they lie back down, they may have POTS. A doctor will carry out a series of tests to confirm a diagnosis of POTS.

What is the main cause of POTS?

It is not fully clear what causes POTS. However, POTS typically occurs when the autonomic nervous system (ANS) is not functioning properly. The ANS is in charge of bodily functions that we do not have to think about, such as heart rate.

POTS can also occur if a person has a low blood volume, or after a person suffers from an infection, illness, or traumatic event.

What does a POTS flare-up feel like?

A person experiencing a POTS flare may feel lightheaded, dizzy, or like they are about to faint when they stand up.

Postural orthostatic tachycardia syndrome typically occurs when the autonomic nervous system is not functioning correctly. When a person has POTS, they may feel dizzy, lightheaded, and faint when they stand up from sitting or lying down.

Other symptoms of POTS can include heart palpitations, chest pain, breathlessness, fatigue, and brain fog.

A person may find that being hot, eating refined carbohydrates, high-impact exercise, and dehydration make their POTS symptoms worse.

Certain tips, such as avoiding alcohol and caffeine, staying hydrated, and standing up slowly, may help relieve POTS symptoms.

If POTS symptoms do not improve with lifestyle changes, a doctor may prescribe medications, such as beta-blockers, fludrocortisone, and midodrine.