Understanding POTS: When standing makes the heart race
Ever rolled out of bed, stood up and had to sit right back down because of dizziness, blurry vision or a racing heartbeat? For people with postural orthostatic tachycardia syndrome, or POTS, that moment isn’t just occasional—it’s a daily challenge.
POTS is a disorder of the autonomic nervous system—the part of the body that controls automatic functions such as heart rate, blood pressure, digestion and temperature regulation. When a person with POTS stands up, blood pools in the lower body instead of flowing back to the heart and brain as it should. To compensate, the heart races, often increasing by 30 beats per minute or more, without a drop in blood pressure.
Common symptoms
Symptoms vary from person to person, but most people with POTS experience:
- Dizziness or lightheadedness after standing
- Rapid heartbeat (palpitations)
- Fatigue or weakness
- Brain fog or trouble concentrating
- Nausea
- Headaches
- Chest pain or shortness of breath
- Fainting or near-fainting episodes
Symptoms often worsen after long periods of standing, hot weather, dehydration or illness.
Related conditions
POTS can occur on its own, but it is sometimes linked to other medical conditions. Some people who have POTS also live with:
- Ehlers-Danlos syndrome (EDS), a group of connective tissue disorders that cause your joints to move more than normal and fragile skin
- Autoimmune diseases, such as lupus or Sjögren’s syndrome
- Chronic fatigue syndrome (myalgic encephalomyelitis)
- Fibromyalgia
- Migraine disorders
- Small fiber neuropathy, which affects the small nerves that control involuntary body functions
These overlapping conditions can make diagnosis more complex and may require coordinated care among multiple specialists.
How is POTS diagnosed
Because symptoms can overlap with other conditions, POTS is sometimes difficult to recognize. Diagnosis typically includes:
- A detailed medical history and physical exam
- Heart rate and blood pressure measurements when lying down and standing
- A tilt table test, which records how the heart rate and blood pressure respond to changes in your body’s position
- Blood tests to rule out other causes, such as thyroid problems or anemia
A diagnosis is usually confirmed when the heart rate increases significantly within 10 minutes of standing, without a significant drop in blood pressure.
Treatment options
There is no single treatment for POTS, but symptoms can often be managed with a combination of lifestyle changes and medical therapies. Common approaches include:
- Increasing fluids and salt intake (under a clinician’s guidance) to improve blood volume
- Wearing compression stockings to help prevent blood from pooling in the legs
- Gradual exercise programs focused on building strength and endurance
- Medications that help regulate heart rate or blood pressure
- Avoiding triggers such as heat, alcohol and prolonged standing
Because every case is different, treatment plans are personalized to meet each patient’s needs.
Living with POTS
While POTS can be challenging, many people see improvement with proper diagnosis and care. Working closely with specialists, such as cardiologists or neurologists familiar with autonomic disorders, can help identify the best combination of therapies for symptom control and improved quality of life.
Care at SIU Medicine
If you think you might be experiencing symptoms of POTS, talk to your primary care provider. SIU Medicine providers understand the complexity of POTS and related conditions. Through a team-based approach, clinicians work to identify underlying causes, create individualized treatment plans and provide ongoing support for patients managing chronic autonomic disorders. With the right care and guidance, many patients find ways to restore balance and live more comfortably with POTS.
