Postural orthostatic tachycardia syndrome (POTS) is a condition that causes your heart to beat faster than normal when you transition from sitting or lying down to standing up.
Each word of “postural orthostatic tachycardia syndrome” has a meaning:
- Postural – related to the position of your body
- Orthostatic – related to standing upright
- Tachycardia – a heart rate over 100 beats per minute
- Syndrome – A group of symptoms that happen together
Your autonomic nervous system normally balances your heart rate and blood pressure to keep your blood flowing at a healthy pace, despite your body’s positioning. However, if you have POTS, your body can’t coordinate the balancing act of blood vessel constriction and heart rate response, meaning your body can’t keep your blood pressure steady and stable. This causes a variety of symptoms, including:
- Dizziness or lightheadedness, especially when standing up, during prolonged standing in one position, or on long walks
- Fainting or near fainting
- Forgetfulness and trouble focusing (brain fog)
- Heart palpitations or a racing heart rate
- Exhaustion/fatigue
- Feeling nervous or anxious
- Shakiness and excessive sweating
- Shortness of breath
- Chest pain
- Headaches
- Nausea
- Bloating
- A pale face and purple discoloration of your hands and feet if they’re lower than the level of your heart
- Disrupted sleep from chest pain, a racing heart rate, or excessive sweating during sleep
POTS symptoms often get worse in the following situations:
- Being in warm environments, such as in a hot bath or shower, or on a hot day
- Standing frequently, such as when you’re waiting in line or shopping
- Participating in strenuous exercise
- When you are sick from a cold or an infection
- Having your period
You can develop POTS suddenly or it can develop gradually. Symptoms vary from person to person. They may happen immediately or a few minutes after sitting up or standing. Lying down may relieve some of the symptoms.
Researchers aren’t sure what causes POTS. They currently believe there are multiple causes, which have been put into different subtypes of POTS, including:
- Neuropathic POTS – this happens when peripheral denervation (loss of nerve supply) leads to poor blood vessel muscles, especially in your legs and abdomen
- Hyperadrenergic POTS – this happens when your sympathetic nervous system is overactive
- Hypovolemic POTS – reduced blood volume can lead to POTS. Low blood volume can cause similar symptoms that may overlap with neuropathic and hyperadrenergic POTS
There is also growing evidence that suggests POTS might be an autoimmune disease, meaning the immune system attacks healthy tissue for unknown reasons.
POTS can be difficult for healthcare providers to diagnose due to the many symptoms that can occur over time. People with POTS may have symptoms for months or years before they are finally diagnosed with the condition.
To confirm a POTS diagnosis or rule out other possible causes for your symptoms, your healthcare provider will ask questions about symptoms, medications, and medical history, and they will also perform a series of tests.
A tilt table test is the main way providers diagnose POTS, as it measures your heart rate and blood pressure as you change your posture and position. A healthcare provider may order other tests to help determine a diagnosis, including:
- Blood and urine tests for causes of POTS and conditions that mimic POTS
- QSART (a test that measures the autonomic nerves that control sweating)
- Autonomic breathing test (a test that measures your blood rate and pressure response during exercise
- Skin nerve biopsy
Unfortunately, there is no cure for POTS. However, healthcare providers use strategies to manage the symptoms. Treatment is highly individualized based on your symptoms and what works best for you. The main forms of treatment include:
- Exercise and physical activity
- Diet and nutrition
There is nothing you can do to prevent developing POTS. But there are steps you can take to try to prevent flare-ups by knowing what your triggers are, including:
- Maintaining a consistent temperature
- Avoiding prolonged standing
- Avoiding alcohol
If you are experiencing any POTS-related symptoms, you can schedule an appointment at Jamaica Hospital Medical Center’s Cardiology Department by calling (718) 206-7100. If you are experiencing an emergency, please call 911 right away.
All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.