What is postural orthostatic tachycardia syndrome (POTS)?

Postural orthostatic tachycardia syndrome (POTS) is a condition that affects circulation (blood flow). It involves the autonomic nervous system (which automatically controls and regulates vital bodily functions) and sympathetic nervous system (which activates the fight or flight response).

POTS is a form of orthostatic intolerance, the development of symptoms that come on when standing up from a reclining position, and that may be relieved by sitting or lying back down. The primary symptom of an orthostatic intolerance is lightheadedness, fainting, and an uncomfortable, rapid increase in heartbeat.

Heart rate and blood pressure work together to keep the blood flowing at a healthy pace, no matter what position the body is in. People with POTS cannot coordinate the balancing act of blood vessel squeeze and heart rate response. This means the blood pressure cannot be kept steady and stable.

Each case of POTS is different. POTS patients may see symptoms come and go over a period of years. In most cases, with proper adjustments in diet, medications and physical activity, a person with POTS will see an improvement in quality of life. Also, if an underlying cause is found and is treated, POTS symptoms may subside.

There are various forms of POTS. The most common are:

  • Neuropathic POTS: Peripheral denervation (loss of nerve supply) leads to poor blood vessel muscles, especially in the legs and core body.
  • Hyperadrenergic POTS: Overactivity of the sympathetic nervous system
  • Low blood volume POTS: Reduced blood volume can lead to POTS. Low blood volume can cause similar symptoms that may overlap in neuropathic and hyperadrenergic POTS

Who is at risk for POTS?

The majority of POTS patients are women ages 13-50 years old. About 450,000 people suffer from POTS in the United States.

  • Patients may develop POTS after a viral illness, serious infections, medical illness, pregnancy, and trauma such as head injury. The condition may develop as aftermath of a significant illness (especially associated with hospitalization and prolonged immobilization).
  • POTS may develop in those who have had a recent history of mononucleosis.
  • People with certain autoimmune conditions such as Sjogren’s syndrome and celiac disease can be at higher risk. Sjogren’s can be evaluated by blood testing, dry eye test, lip biopsy, and rheumatology consult. Celiac disease can be tested through blood work, gastroenterology consult, and if needed biopsies of the small intestines

What are the symptoms of postural orthostatic tachycardia syndrome (POTS)?

POTS symptoms can be uncomfortable and frightening experiences. Patients with POTS usually suffer from two or more of the many symptoms listed below. Not all patients with POTS will have all these symptoms.

  • High/low blood pressure
  • High/low heart rate; racing heart rate
  • Chest pain
  • Dizziness/lightheadedness especially in standing up, prolonged standing in one position, or long walks
  • Fainting or near-fainting
  • Exhaustion/fatigue
  • Abdominal pain and bloating, nausea
  • Temperature deregulation (hot or cold)
  • Nervous, jittery feeling
  • Forgetfulness and trouble focusing (brain fog)
  • Blurred vision
  • Headaches and body pain/aches (may feel flu-like); neck pain
  • Insomnia and frequent awakenings from sleep, chest pain and racing heart rate during sleep, excessive sweating
  • Shakiness/tremors especially with adrenaline surges
  • Discoloration of feet and hands
  • Exercise intolerance
  • Excessive or lack of sweating
  • Diarrhea and/or constipation