POTS (Postural Orthostatic Tachycardia Syndrome)

February 7, 2022

4 min read

Postural orthostatic tachycardia syndrome, or POTS, is a medical condition that affects between one to three million Americans. While this condition has the potential to affect anyone, it most commonly affects women aged 15 to 50. Below we will dive into the most common forms of POTS and who is at an increased risk of developing this chronic condition.

What does POTS stand for?

(P) Postural: Postural is related to the posture of your body
(O) Orthostatic: Related to standing in an upright position
(T) Tachycardia: Elevated heart rate
(S) Syndrome: Related to a group of symptoms

What is postural orthostatic tachycardia syndrome?

Postural orthostatic tachycardia syndrome is a common medical condition that affects blood flow. This condition involves both the autonomic nervous system that controls and regulates vital bodily functions and the sympathetic nervous system which activates the fight or flight response.

Common forms of postural orthostatic tachycardia syndrome

While there are several forms of POTS, the Cleveland Clinic reports that below are the most commonly reported forms.

Neuropathic postural orthostatic tachycardia syndrome: This form of POTS is caused by a loss of nerve supply leading to poor blood vessel muscles, specifically in the legs and core of the body.
Hyperandrenergic postural orthostatic tachycardia syndrome: Hyperadrenergic POTS is caused by an overactive sympathetic nervous system.
Hypovolemic postural orthostatic tachycardia syndrome: Hypovolemic POTS is caused by low blood volume. It can cause similar symptoms that may overlap in neuropathic and hyperadrenergic postural orthostatic tachycardia syndrome.

Signs and symptoms associated with POTS

POTS is characterized by a group of symptoms that frequently occur when standing up for more than 10 minutes. For adults, it is associated with a change in heart rate of 30 beats per minute while in adolescents it is associated with a change of 40 beats per minute. In addition to this, the following are commonly reported symptoms according to the U.S. Department of Health and Human Services:

Hyper/hypotension
Brady/tachycardia
Chest pain
Dizziness or lightheadedness when standing or taking long walks
Fainting
Exhaustion
Fatigue
Gastrointestinal problems including bloating, nausea, vomiting, or abdominal pain
Temperature deregulation
Nervous, jittery feeling
Forgetfulness or trouble remembering
Blurred vision
Headaches, body aches, pains
Insomnia
Tremors
Discoloration of the hands and/or feet
Exercise intolerance
Diarrhea and/or constipation

Symptoms of postural orthostatic tachycardia syndrome worsen in warm environments, in situations that require prolonged or excessive amounts of standing, and after a missed meal due to inadequate fluid and salt intake. It is important to recognize these triggers in an attempt to avoid situations that may exacerbate or worsen your symptoms.

How is postural orthostatic tachycardia syndrome diagnosed?

Postural orthostatic tachycardia syndrome requires a medical diagnosis from a licensed professional. Your primary care physician will often perform:

Blood and urine testing
QSART
Autonomic breathing test
Tuberculin skin test
Skin nerve biopsy
Echocardiogram
Blood volume with hemodynamic status

Most importantly, your physician will perform what is called the tilt table test. This measures your heart rate and blood pressure as you change your posture and position. This is the most reliable form of testing doctors perform and trust.

Who is at risk for developing POTS?

Patients who have recently suffered from a viral illness, serious infection, pregnancy, or some type of trauma are at an increased risk of developing postural orthostatic tachycardia syndrome. In addition, those suffering from certain autoimmune diseases, such as celiac disease or Sjogren’s syndrome are at risk, as well as those with a recent bout of infectious mononucleosis or Epstein Barr Virus.

Dysautonomia International has reported that a Mayo Clinic survey conducted on pediatric patients treated between 2003 to 2010 for POTS with a reported 18.2% of patients seeing a complete symptom resolve and 52.8% of patients reported persistent but improved symptoms associated with postural orthostatic tachycardia syndrome. Of these patients, it was noted that male patients were two times as likely to see a full recovery of symptoms than female patients that were treated.

Managing POTS

Postural orthostatic tachycardia syndrome can be treated with a mix of diet, exercise, and occasionally requires medications to treat the underlying cause or symptoms associated with this disorder.

The POTS diet is designed for patients to achieve a fluid intake goal of 64-48 ounces of water each day, as well as add an adequate amount of salt into their diet. These changes being added into your diet allow for more blood to flow through your body reaching both the heart and the brain.

Medications prescribed for POTS are typically designed to focus on an increase of blood flow when diet and exercise alone are not enough, aid in the kidney’s ability to retain salt and reduce your heart rate when your body is no longer able to regulate it on its own.

It is important that you make an appointment with your primary care physician immediately if you experience any of these mild to moderate symptoms mentioned above or if you have any questions or concerns regarding your health.

Foundations and Societies

Dysautonomia International

Get Support for POTS

Support groups can play an important role in living with postural orthostatic tachycardia syndrome (POTS). Reach out to other Healthread users to talk about your POTS symptoms and what you're doing that is helping you manage them.