Postural orthostatic tachycardia syndrome (POTS) is a condition that causes a number of symptoms when you transition from lying down to standing up, such as a fast heart rate, dizziness and fatigue. While there’s no cure, several treatments and lifestyle changes can help manage the symptoms of POTS.
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. It’s a type of orthostatic intolerance.
Each word of “postural orthostatic tachycardia syndrome” has a meaning:
Normally, your body’s autonomic nervous system balances your heart rate and blood pressure to keep your blood flowing at a healthy pace, no matter what position your body is in. If you have POTS, your body can’t coordinate the balancing act of blood vessel constriction (squeezing) and heart rate response. This means that your body can’t keep your blood pressure steady and stable. This causes a variety of symptoms.
Each case of POTS is different. People with POTS may see symptoms come and go over a period of years. In most cases, with adjustments in diet, medications and physical activity, a person with POTS will experience an improvement in their quality of life.
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The majority of people with POTS are women and people assigned female at birth aged 15 to 50 years. But men and people assigned male at birth can also have POTS.
You’re at a higher risk of developing POTS after experiencing the following stressors:
People who have certain autoimmune conditions, such as Sjogren’s syndrome, lupus and celiac disease, are also more likely to develop POTS.
POTS is common. It affects about 1 to 3 million people in the United States.
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Normally, when you stand up, gravity causes about 10% to 15% of your blood to settle in your abdomen, legs and arms. This means that less blood reaches your brain, which can cause brief lightheadedness. If you don’t have POTS, this lightheaded feeling doesn’t happen often because your leg muscles help pump blood back up to your heart.
In addition, your autonomic nervous system turns on a series of rapid responses. To compensate for the lower amount of blood returning to your heart after standing up, your body releases the hormones epinephrine (adrenaline) and norepinephrine.
These hormones typically cause your heart to beat a little faster and with more force. Norepinephrine also causes your blood vessels to tighten or constrict. This all results in more blood returning to your heart and brain.
People with POTS tend to pool a larger amount of blood in vessels below their heart when they stand. Their body responds by releasing more norepinephrine or epinephrine to try to cause more squeezing of their blood vessels. For several reasons, their blood vessels don’t respond normally to these hormones. Because their heart remains able to respond to the norepinephrine and epinephrine, their heart rate often increases.
This imbalance causes many possible symptoms, such as dizziness, fainting and exhaustion.
While POTS isn’t life-threatening, it can greatly interfere with daily living and tasks. The good news is that a variety of treatments and strategies can help improve symptoms.
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You can develop POTS suddenly or it can develop gradually.
Symptoms happen immediately or a few minutes after sitting up or standing. Lying down may relieve some of the symptoms.
POTS has several possible symptoms, and they vary from person to person. Symptoms include:
POTS symptoms often get worse in the following situations:
Researchers aren’t sure yet what exactly causes POTS. Currently, they think there are multiple causes, which they’ve grouped into different subtypes of POTS, including:
There’s also growing evidence suggesting that POTS might be an autoimmune disease, meaning your 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 to years before finally being diagnosed with the condition.
A healthcare provider will ask questions about your symptoms, medications and medical history. They’ll also perform a physical exam.
A tilt table test is the main way providers diagnose POTS. The tilt table test measures your heart rate and blood pressure as you change posture and position.
Besides the tilt table test, your provider may order other tests to help confirm a POTS diagnosis or rule out other possible causes of your symptoms, including:
Unfortunately, there’s no cure for POTS. Instead, healthcare providers use several strategies to manage the symptoms of POTS. Treatment is highly individualized based on your symptoms and what works best for you.
The main forms of treatment include:
Medical compression stockings can also help push blood up from your legs to reduce POTS symptoms.
Exercise and physical activity are key to managing POTS.
Although most people with POTS have healthy hearts, your provider may recommend a cardiac rehab program. This exercise template uses the cardiac rehab model to recondition and help improve health and manage POTS. Some of the best data for treating POTS comes from cardiac rehab.
Studies show that reclined aerobic exercise, such as swimming, rowing and recumbent bicycling, has the best results. Strengthening your core and leg muscles is also helpful.
Here are important things to know as you undergo an exercise program and other physical activities. Talk with your provider for specific instructions on these exercises.
Managing diet and nutrition is another important aspect of managing POTS symptoms.
If you have the hypovolemic (low blood volume) form of POTS, your healthcare provider will likely recommend increasing both your fluid and salt intake to increase blood volume.
Eating a large meal can make symptoms of POTS worse, as your body redirects a lot of blood to aid in the digestion process. Because of this, providers often recommend eating several smaller meals throughout the day instead of two or three large ones.
A nutritionist or dietitian can help you with your diet. This consult can be especially helpful if you have celiac disease or other dietary sensitivities.
General guidelines for dietary changes include:
The U.S. Food and Drug Administration (FDA) hasn’t approved any medications for POTS treatment. But healthcare providers sometimes prescribe medications off-label to help certain POTS symptoms.
These medications include:
All of these medications have potential side effects. Your provider will work with you to see if medication is right for you.
Aside from exercise and dietary changes, other things you can do to manage POTS include frequently monitoring your pulse and blood pressure and getting quality sleep.
Taking and writing down your blood pressure and pulse can provide insight into POTS and helps your healthcare provider fine-tune your treatment.
Check your blood pressure and pulse at the same time daily (in the morning and after dinner). It’s very helpful to do this for the first few months of your diagnosis. Also, check your blood pressure and pulse when you aren’t feeling well.
You can get a blood pressure monitor at most drug stores, online or at a medical supply store
POTS can disrupt your sleep. As sleep is very important for overall health, you should prioritize it. These general guidelines may help you:
Talk to your provider if POTS is significantly disrupting your sleep.
Unfortunately, there’s 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.
Some general guidelines for preventing flare-ups include:
The prognosis (outlook) for POTS is generally good, although it can severely disrupt daily living. POTS symptoms may come and go for years. In approximately 80% of cases, the condition improves, but many people have residual symptoms.
The biggest risk to people with POTS is getting hurt if they faint and fall.
People with POTS have a normal life expectancy. The condition doesn’t decrease life expectancy.
Postural orthostatic tachycardia syndrome can be challenging to live with. Here are some things you can do to take care of yourself:
If standing up causes unusual symptoms, such as lightheadedness and a pounding heart rate, see a healthcare provider.
If you have POTS, try to see a healthcare provider who specializes in POTS to get the best care. You’ll also need a primary care physician to go to for routine care and health wellness management.
A note from Cleveland Clinic
Learning that you have postural orthostatic tachycardia syndrome (POTS) can be overwhelming. Know that there are several treatments and lifestyle adaptations that can help manage your symptoms. No two people with POTS are affected in the same way, so it’s important to receive individualized care that’s unique to your situation. Don’t be afraid to ask your healthcare provider questions about POTS. They’re available to help you.
Last reviewed on 09/09/2022.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy