Postural Orthostatic Tachycardia Syndrome (POTS)

Postural orthostatic tachycardia syndrome is a group of symptoms that occur when a person stands up after lying down.

POTS occurs when less blood than normal flows to the body when you stand up. The reduced blood flow to the body makes the heart beat rapidly.

POTS may be associated with another medical condition, or it may occur on its own.

What are the causes?

The cause of this condition is not known, but many conditions and diseases are associated with it.

What increases the risk?

This condition is more likely to develop in:

• Women 15–50 years old.
• Women who are pregnant.
• Women who are in their period (menstruating).
• People who have certain conditions, such as:
  • Infection from a virus.
  • Attacks of healthy organs by the body’s immunity (autoimmune disease).
  • Losing a lot of red blood cells (anemia).
  • Losing too much water in the body (dehydration).
  • An overactive thyroid (hyperthyroidism).
• People who take certain medicines.
• People who have had a major injury.
• People who have had surgery.

What are the signs or symptoms?

The most common symptom of this condition is light-headedness when one stands from a lying or sitting position. Other symptoms may include:

• Feeling a rapid increase in the heartbeat (tachycardia) within 10 minutes of standing up.
• Fainting.
• Weakness.
• Confusion.
• Trembling.
• Shortness of breath.
• Sweating or flushing.
• Headache.
• Chest pain.
• Breathing that is deeper and faster than normal (hyperventilation).
• Nausea.
• Anxiety.

Symptoms may be worse in the morning, and they may be relieved by lying down.

How is this diagnosed?

This condition is diagnosed based on:

• Your symptoms.
• Your medical history.
• A physical exam.
• Checking your heart rate when you are lying down and after you stand up.
• Checking your blood pressure when you go from lying down to standing up.
• Blood tests to measure hormones that change with blood pressure. The blood tests will be done when you are lying down and when you are standing up.

You may have other tests to check for conditions or diseases that are associated with POTS.

How is this treated?

Treatment for this condition depends on how severe your symptoms are and whether you have any conditions or diseases that are associated with POTS. Treatment may involve:

• Treating any conditions or diseases that are associated with POTS.
• Drinking two glasses of water before getting up from a lying position.
• Eating more salt (sodium).
• Taking medicine to control blood pressure and heart rate (beta-blocker).
• Avoiding certain medicines.
• Starting an exercise program under the supervision of a health care provider.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Let your health care provider know about all prescription or over-the-counter medicines. These include herbs, vitamins, and supplements. You may need to stop or adjust some medicines if they cause this condition.
• Talk with your health care provider before starting any new medicines.

Eating and drinking

• Drink enough fluid to keep your urine pale yellow.
• If told by your health care provider, drink two glasses of water before getting up from a lying position.
• Follow instructions from your health care provider about how much sodium you should eat.
• Avoid heavy meals. Eat several small meals a day instead of a few large meals.

General instructions

• Do an aerobic exercise for 20 minutes a day, at least 3 days a week.
• Ask your health care provider what kinds of exercise are safe for you.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can interfere with blood flow. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Your symptoms do not improve after treatment.
• Your symptoms get worse.
• You develop new symptoms.

Get help right away if:

• You have chest pain.
• You have difficulty breathing.
• You have fainting episodes.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

• POTS is a condition that can cause light-headedness, fainting, and palpitations when you go from a sitting or lying position to a standing position. It occurs when less blood than normal flows to the body when you stand up.
• Treatment for this condition includes treating any underlying conditions, drinking plenty of water, stopping or changing some medicines, or starting an exercise program.
• Get help right away if you have chest pain, difficulty breathing, or fainting episodes. These may represent a serious problem that is an emergency.