Postural Orthostatic Tachycardia Syndrome (PoTS)
Postural orthostatic tachycardia syndrome (PoTS) is when the heart rate increases abnormally after sitting up or standing. It’s a problem of the nervous system and needs specialist management.
What is postural orthostatic tachycardia syndrome?
Postural orthostatic tachycardia syndrome (PoTS) is when the heart rate increases abnormally after sitting up or standing. Whilst it affects various types of people, it's most common in girls and women between 15 and 50 years old.
When you sit up or stand, gravity pulls your blood down to your lower abdominal area, hands and feet. As this happens, the blood vessels narrow quickly, and your heart rate naturally increases to maintain blood flow to the brain and heart. This process is controlled by your autonomic nervous system (the part of the nervous system that controls unconscious tasks such as breathing).
Those with PoTS have an autonomic nervous system that doesn’t work properly, so the narrowing of the blood vessels doesn’t happen when they stand. This causes a sudden drop in blood supply to the heart and brain, and the heart races to compensate for this. Typically, the heart rate increases by about 10 to 15 beats per minute after standing, but patients with PoTS can experience increases of 30 to 50 beats per minute.
Our cardiologists see patients with PoTS in our state-of-the-art Heart Health centre. They use the most advanced diagnostics and treatment options to provide the best possible care.
More information
PoTS can come on suddenly or can gradually develop over time, but symptoms usually appear within a few minutes of sitting up or standing. These symptoms include:
dizziness
fainting
heart palpitations
shaking
sweating
weakness and fatigue
headaches
chest pain
nausea
shortness of breath
Some other common symptoms which often go unnoticed include a lack of sleep, gut problems (which sometimes get misdiagnosed as IBS), tiredness, and bladder problems. Some women find symptoms are worse when they’re on their period.
The most common cause of PoTS is when people have a problem with their nervous system. It can develop suddenly after a viral illness or traumatic event.
Other known causes include:
joint hypermobility syndromes (Ehlers-Danlos syndromes) – unusually flexible joints and abnormally elastic blood vessels
conditions such as diabetes, amyloidosis, sarcoidosis, lupus, Sjogren’s syndrome, or cancer
alcohol or metal poisoning
inheriting faulty genes, for example, those that cause overproduction of noradrenaline
At your initial consultation at our Heart Health centre, your cardiologist will talk to you about your symptoms and medical history and check to see if your heart rate increases by 30 beats per minute or more within 10 minutes of standing.
Tests may include:
a tilt table test – your heart rate and blood pressure are measured whilst lying on a bed, then the bed is tilted into an upright position whilst still measuring heart rate and blood pressure
active stand test – heart rate and blood pressure are measured after lying down, immediately after standing, and after 2, 5 and 10 minutes
an electrocardiogram (ECG) – to look at the heart’s electrical activity
an echocardiogram – an ultrasound of the heart
24-hour ambulatory blood pressure and heart rate monitoring – to help look at your blood pressure and heart rate during a normal day of activity
blood tests
It’s not possible to prevent PoTS, but there are ways to manage the problem to limit the symptoms.
PoTS symptoms may be reduced by:
drinking plenty of fluids
sitting or standing up slowly
raising the head of your bed so you’re not fully horizontal at night
cutting down on caffeine and alcohol
avoiding standing for long periods of time
wearing compression stockings
Although in some people exercise can trigger symptoms, staying active may help in the long term by improving blood flow. You can try exercises that are done lying or sitting down, such as swimming or rowing, and gradually build these up over time.
PoTS can usually be managed so that there are no complications, but if it's left unmanaged, it can lead to further complications.
Complications of PoTS include:
injuries from fainting or falls
severe fatigue
cognitive issues, such as brain fog
gastrointestinal problems, such as chronic nausea and severe constipation, which may lead to malnutrition
PoTS can also lead to depression and anxiety due to the chronic nature of the illness.
There’s no cure for PoTS, but with careful management, symptoms can usually be significantly reduced.
Your cardiologist will talk to you about ways to manage your PoTS symptoms, including:
drinking plenty of fluids
sitting or standing up slowly
raising the head of your bed so you’re not fully horizontal at night
cutting down on caffeine and alcohol
avoiding standing for long periods of time
wearing compression stockings
If lifestyle changes do not help your condition, other options may include:
medication, such as steroids, or drugs used to control blood pressure or regulate heart rate
a pacemaker – a small device that sends electrical pulses to your heart to keep it beating regularly
At Welbeck, our cardiologists are experts in their field and are dedicated to providing world-class care to every patient.
With access to colleagues across other specialties, our consultants are also able to refer within the Welbeck ecosystem if required to ensure you receive the treatment you need as quickly as possible, all under one roof.
All appointments, testing, treatment, and follow-up appointments take place within our state-of-the-art facilities, enabling us to deliver accurate diagnostics and advanced treatments.
Your health is important to us, so we strive to offer same-day appointments whenever possible.
Our consultants are recognised by the major health insurance companies. If you have private health insurance, your treatment at Welbeck can begin once you have obtained authorisation. We also provide care to self-paying patients. Learn more about the different payment options at Welbeck.
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Frequently asked questions
Yes, many people who suffer from PoTS say that their symptoms vary day to day or even hour to hour. This is because many things can impact symptoms, such as hydration levels, temperature, and hormones. It's important to work with your cardiologist to find out what makes your symptoms worse.
It’s not yet fully understood whether COVID-19 can directly cause PoTS. However, viral infections are known to trigger PoTS in some cases, and there’s evidence that some people with long COVID experience symptoms similar to those of PoTS. If you're experiencing PoTS-like symptoms after having COVID-19, it's important to see a specialist for an accurate diagnosis.
Most women with PoTS will have a normal pregnancy and deliver a healthy baby with minimal complications, but it’s important to discuss becoming pregnant with your cardiologist. You may need specialist care during your pregnancy to keep an eye on your PoTS symptoms, and it might be necessary to modify your PoTS medication.
PoTS is a condition of the nervous system and is not caused by stress or anxiety, although some of the symptoms may be the same, such as a racing heart or sweating. Stress and anxiety can make PoTS symptoms worse if you are already suffering from PoTS. It's important to speak to a doctor if you have PoTS symptoms and anxiety so that you can get an accurate diagnosis and appropriate treatment.