Overview

Postural Orthostatic Tachycardia Syndrome (PoTS) is a serious condition that happens when your heart beats very fast after getting up from either lying down, standing up, or sitting.

We do not yet know why people have PoTS but there are things that you can do to feel better and possibly recover from the condition.

Can you explain what PoTS is?

Have you recently been told that you have Postural Orthostatic Tachycardia? It is also sometimes called Postural Tachycardia Syndrome and is commonly abbreviated as PoTS. 

Professor Lesley Kavi, a GP with a special interest in PoTS and a member of the trustee and Chairperson of PoTS UK explains that “PoTS is a condition that causes an abnormal increase in your heart rate after sitting up or standing up”, according to the British Heart Foundation.

When you sit up or stand, the body reacts by dropping the blood pressure to allow for blood to flow downward in your body. The body then responds to this by narrowing the blood vessels to slightly cause an increase in the heart rate. This is important as it helps to maintain enough blood supply to the heart and brain by preventing an unusual fall in blood pressure, which otherwise can cause you to fall backwards when you stand up.

So, let’s break down the words that form PoTS:

Postural: relates to the position of the body, which is whether you’re sitting or standing. 

Orthostatic: relates to being in an upright position.

Tachycardia: means an increased heart rate.

This means that people with PoTS do not have the body’s automatic changes to reduce the heart rate after an upright position, and therefore, PoTS symptoms are triggered by the body’s movement to a sitting upright, or standing position.

Diagnostic criteria

You should see your doctor if you feel like you might have PoTS. Your doctor will want to ask about the symptoms, ask for some other tests, and measure your heart rate and your blood pressure while lying and standing. PoTS is usually characterised by an excessive increase in heart rate upon standing with some mild symptoms such as dizziness or lightheadedness, which get better when lying down.

However, you should know that some of the symptoms can also be due to low blood pressure and does not necessarily mean that you have PoTS always check these symptoms with your doctor.

Who is affected by PoTS?

According to some studies, women are more likely to get PoTS than men, although men can also have it.¹ It is also less common in young children and more common in young adults, with genetic disorders being a risk factor.²

Symptoms of PoTS

Some common symptoms that happen after standing or sitting up include

• Dizziness and light-headedness
• Noticeably fast heartbeat
• Fainting or almost fainting

These symptoms usually go away when you lie down, but there are other symptoms that don’t, which are:

• Feeling or being sick with or without diarrhoea, constipation, or tummy pain
• Headaches with blurry vision
• Fatigue or extreme tiredness
• Problems with your concentration or thinking

Impact on daily life

For some people, the symptoms can be mild and eventually go away, but if left untreated, they can be life-changing and you may find the symptoms quite severe and affect their overall quality of life. You might be glad to know that some lifestyle measures can help improve these symptoms, and in some cases, medications can be offered to some people.

What triggers PoTS?

The main causes and origin of PoTS are not yet fully understood, but researchers have understood that some of the symptoms are made worse by

• Potential triggers include blood circulation issues caused by warm environments, such as a hot shower or hot day³
• Dysautonomia: some studies suggest that people with families that have a genetic condition such as joint hypermobility disorders, including Ehlers-Danlos syndrome⁴
• Underlying conditions associated with PoTS such as diabetes, lupus or people with high levels of a stress hormone called norepinephrine

How do I know if I have PoTS?

Your doctor is the best person to discuss this with especially if you have some of the symptoms mentioned. Your doctor would want to know and might ask you about your symptoms and medical history, as well as carry out other tests such as:

1. Tilt table test: This involves you being secured on a table while lying flat. Then the table is raised to an almost upright position while your heart rate, blood pressure and often blood oxygen and carbon dioxide levels are also measured. These help measure if you have PoTS by meeting all three of these criteria:
   1. You have a fast heart rate when you are upright
   2. Your symptoms worsen when you sit up or stand up
   3. You don’t develop low blood pressure in the first three minutes of the test
2. In some cases, other diagnostic tests might be necessary to exclude other causes of your symptoms such as
   1. Valsalva manoeuvres: to test your response to the autonomic changes that control the heart
   2. A quantitative sudomotor axon reflex test (QSART) is used to measure your body’s response to regulating sweating
   3. Although less common, your doctor may also ask for some specialist blood or urine tests. Your doctor can also ask for an echocardiogram (ECG) (for heart rate and blood pressure) or an MRI scan and other imaging tests to rule out tumours or other problems

Treatment options

How do you fix postural orthostatic tachycardia? There is no exact cure for PoTS and treatment may vary from person to person, so you should discuss this with your doctor. Finding the right treatment might take time, and your doctor might refer you to a specialist doctor. The specialist may suggest:

Lifestyle modifications 

This may include managing stress and ensuring that you are eating and drinking at regular times and not skipping meals.

Medications

The specialist may suggest that you take some medicines this can be trying different ones or a combination of medicines. Some of the medicines commonly prescribed are beta blockers, and selective serotonin reuptake inhibitors (SSRIs) to help control some of the symptoms.

Physical therapy

For some people with PoTS, having to exercise can make the symptoms worse This is where physical therapy can help, as it involves creating an exercise plan with your specialist that starts slowly and gradually builds up to your tolerance level.

Some experts have suggested aquatic therapy can also help as the water helps to create pressure around your body which in turn allows for better blood circulation.

Management of coexisting conditions

There are some things that you can do to try to help with your symptoms when it happen.

• If you suddenly feel lightheaded or dizzy, you can try lying down and if you can, raise your feet up until you feel better
• And if you’re unable to lie down, you can try crossing your legs in front of each other while standing, clenching your fists, buttocks, and tummy while rocking your toes up and down

Ongoing care and support

Some other things you can do to help with PoTS include

• Avoiding lots of caffeine drinks such as coffee and alcohol
• Drinking plenty of fluids. About 2 litres of water a day is recommended
• Try not to get up too quickly, but sit for a while or stand up slowly after lying down
• Raise the head of your bed to avoid lying completely flat when lying down or sleeping
• Avoid standing up for too long
• Some people might be advised to increase their salt intake to help keep water in the bloodstream, which in turn helps more blood reach the heart and the brain. But, only do this if it has been advised by your doctor as too much salt can also be harmful

Long-term outlook

Although the long-term outlook of PoTS is not well known it is estimated that about 50% of patients usually recover after 1-3 years of diagnosis.³

As we now know the symptoms of PoTS can vary day by day and some people have reported that their symptoms are worse in the morning. But if you feel like your symptoms are not getting better and it is having a negative impact on your lifestyle, you should always speak to your doctor about it.

Furthermore, since PoTS mostly affects women, does PoTS affect pregnancy? Again, the symptoms of PoTS vary between individuals as some studies found that some women had no issues during pregnancy whilst others had it tough. But in general, there seems to be no effect of this on most newborns, and they are as healthy as the babies born to mothers without PoTS.⁵

Quality of life considerations

It’s understandable that having PoTS can be life-changing but you can rest assured that it is not life-threatening and there are ways to help avoid the risk and improve your symptoms. Do remember to keep active every day but take things gently and only do as much as you can tolerate.

Research and advances

More research is being done to understand PoTS better and hopefully help find effective treatments. 

There is also some emerging evidence that some people who had long-term COVID symptoms also have similar symptoms to PoTS. You should talk to your doctor about this so that you are correctly diagnosed and treated appropriately.

Support for PoTS patients

You can find out more information and support from PoTS UK and STARS, which are charities with helplines for people living with PoTS.

Summary

PoTS is a serious condition but is not life-threatening. Some of the symptoms can be made worse by warm conditions that affect blood circulation, which can cause you to have severe symptoms, such as dizziness, extreme tiredness or even fainting. However, some of these symptoms can be caused by low blood pressure, therefore, you should let your doctor know if you feel like you have PoTS symptoms so that you can be correctly diagnosed and treated.

Maintaining a healthy lifestyle, drinking plenty of fluids and avoiding coffee and alcohol can help reduce your symptoms. PoTS UK and STARS are charities with available support dedicated to patients with PoTS.