What Is Postural Orthostatic Tachycardia Syndrome (POTS)?

Postural orthostatic tachycardia syndrome (POTS) causes fatigue and anxiety. Here's how lifestyle changes can reduce or eliminate symptoms.

Imagine you are a woman who often feels weak, inexplicably light-headed, and notices her heart beating unusually fast when she stands. Your doctor says you appear healthy and suggests you are suffering from anxiety and depression. What you really may be suffering from, however, is postural orthostatic tachycardia syndrome (POTS).

While people of any gender or age, including children and seniors, can develop POTS, women between the ages of 15 to 50 are more likely to have this sometimes frightening condition, according to the National Institute of Neurological Disorders and Stroke (NINDS). In fact, 75 to 80 percent of people with POTS are women.

If you’ve ever felt faint for a moment when you suddenly stood up too quickly, or experienced lightheadedness after becoming dehydrated from exercise or standing a long time in a hot environment, you’ve likely had a drop in blood pressure. That’s not uncommon. But people with POTS feel lightheaded sometimes daily and may even faint frequently from standing or simply getting out of bed.

POTS has other symptoms, too, and the result can be a debilitating condition which limits physical activity, making the condition worse.

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POTS has multiple symptoms

The answer to the question “what is POTS?” involves a cluster of symptoms. Orthostatic intolerance is one of the key features of the condition, according to the National Center for Advancing Translational Sciences (part of the National Institutes of Health).

Normally, when you stand upright, your body’s autonomic nervous system quickly causes your body to respond to gravity’s effect on blood flow. After about 60 seconds, your heart rate normally goes up a little (just 10 to 15 beats per minute) and blood pressure increases slightly. But orthostatic intolerance means this normal regulation is out of whack. Blood pressure can fall drastically, causing lightheadedness and even fainting, which can be eased if you quickly lie down.

In people with POTS, orthostatic intolerance is also accompanied by a rapid and excessive increase in heart rate: it can soar to 120 beats per minute or even higher. Some people with the condition also develop a reddish-purple color in their lower legs when they stand, thought to be due to blood pooling. The color change goes away once they recline again.

Other frequent POTS symptoms include:

• Blurred vision
• Shortness of breath
• Heart palpitations
• Headache
• Poor concentration
• Unusual fatigue and weakness
• Gastrointestinal symptoms (nausea, cramps, bloating, constipation, diarrhea)
• Head, neck, or chest discomfort
• Sleep disorders
• Difficulty exercising
• Anxiety
• Coldness or pain in the extremities

What is POTS caused by and how is it treated?

So far, researchers don’t know what causes the orthostatic intolerance and rapid heartbeat associated with POTS. There may be multiple causes, including overactivity of the sympathetic nervous system and significant deconditioning. People with POTS may have low blood volume (meaning they are chronically dehydrated), too.

Some women develop episodes of POTS symptoms before their menstrual periods. NINDS also points out doctors have noticed POTS often begins after a pregnancy, major surgery, trauma, or a viral illness — all events that can cause a person to become inactive and deconditioned.

A diagnosis of POTS is usually made based on the constellation of symptoms and possible tilt table testing (to document blood pressure drops).

There’s no one-size-fits all treatment for everyone with POTS. In some cases, the medications fludrocortisone and midodrine in low doses are used to increase blood volume and narrow blood vessels. However, some simple lifestyle changes are often effective, if you keep at them. For example, adding extra salt to your diet and paying attention to adequate fluid intake daily is important. NINDS recommends drinking 16 ounces of water (2 glassfuls) before getting up to help raise blood pressure.

One of the best things you can do for POTS, although it can be hard to get going, is to start an exercising, even if you have to begin with only minutes a day. Research shows becoming more fit over time will gradually improve orthostatic tolerance.

A case in point: Astronauts returning from long space flights have developed POTS symptoms and often fainted when they returned home. But some of the most effective self-help measures for people on Earth with POTS, it turns out, was found to help astronauts avoid the condition.

Cardiologist Benjamin Levine, MD, a professor of internal medicine at University of Texas Southwestern, who has worked in space research for three decades, documenting that having astronauts exercise an hour or more while on their flights, and having extra hydration and salt when they returned home, prevented POTS.

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