Postural Orthostatic Tachycardia Syndrome (POTS)

Postural orthostatic tachycardia syndrome, commonly called POTS, is a blood circulation disorder. It causes a rapid heart rate when moving from a seated to a standing position.

This increase in heart rate may be uncomfortable and, upon standing, can cause:

  • Dizziness
  • Lightheadedness
  • Fainting

When POTS symptoms are severe, they can impact your quality of life.

The team at the UPMC Heart and Vascular Institute has expertise in diagnosing and managing POTS and other heart and vein conditions.

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What Is Postural Orthostatic Tachycardia Syndrome (POTS)?

POTS stands for:

  • Postural — means posture or the position of your body.
  • Orthostatic — a drop in blood pressure when you stand up after sitting or lying down.
  • Tachycardia — a rapid heart rate.
  • Syndrome — a group of symptoms.

In a healthy person, the autonomic nervous system (ANS) controls involuntary actions in your body like:

  • Blood pressure.
  • Heart rate.
  • The speed of blood flow.

When changing position, such as sitting or standing, the heart rate must increase and blood vessels must tighten. This lets blood pump against the forces of gravity and keeps your circulation moving at a normal pace.

POTS is an abnormal response to your ANS, causing most of your blood to stay in your lower body when you stand.

With POTS, this malfunction in the ANS can cause:

  • A fast heart rate.
  • A drop in blood pressure.
  • Lightheadedness, dizziness, or fainting.

These symptoms occur because your heart must beat even faster to get blood to the brain and rest of the body.

POTS affects between 1 to 3 million Americans, 80% of whom are female.

With the right treatment, symptoms will often improve.

Types of POTS

There are three main types of POTS. In some cases, they can overlap and occur at the same time.

Types of POTS include:

  • Hypovolemic POTS — caused by low circulating blood levels.
  • Neuropathic POTS — caused by damage to the peripheral nerves that manage how certain blood vessels expand and contract.
  • Hyperadrenergic POTS — caused by an overactive sympathetic (fight or flight) nervous system.

POTS causes

POTS isn't a disease. Instead, it's a group of symptoms from an underlying issue.

The symptoms happen when:

  • There isn't enough blood volume circulating through your body, often due to dehydration or low red blood cell counts (anemia).
  • Blood pools in parts of your body below your heart. This occurs when blood vessels can't constrict (tighten) properly and return the blood back up to your heart.
  • You have elevated levels of epinephrine and norepinephrine (your fight-or-flight hormones).

Sometimes, the exact cause of POTS isn't clear. In many cases, an existing health issue that affects the ANS can trigger POTS.

Although doctors haven't found all the underlying causes of POTS, they believe the following conditions are involved:

  • Amyloidosis — a disease in which abnormal proteins collect in tissues and organs.
  • Anemia — low red blood cell counts.
  • Autoimmune diseases like lupus, Sjogren's syndrome, and MS.
  • Diabetes.
  • Ehlers-Danlos syndrome — a disorder that affects your connective tissue.
  • Genetic defects.
  • Infections like mono, Lyme disease, and hepatitis C.
  • Trauma from a surgery or recent pregnancy.

Some POTS symptoms, such as rapid heartbeat and sweating, are like those of anxiety disorders and panic attacks. But doctors don't think they're an underlying cause of POTS.

POTS risk factors and complications

Anyone can get this condition, but it's more common in:

  • Women between 15 and 50 years old.
  • Those with a family history of POTS.
  • People suffering toxicity from alcohol, chemo, or heavy metal.
  • People with vitamin and mineral deficiencies, such as iron deficiency anemia.
  • Those with the underlying health conditions listed above.

POTS is not life-threatening and will not cause heart failure, but the symptoms can impact your life.

The most severe complication of POTS is trauma or an injury from falling or fainting.

How to prevent POTS

You can't prevent POTS, but you can ease symptoms by managing the underlying cause. In some cases, you may be able to prevent future episodes by making diet and lifestyle changes.

If you have symptoms, talk to your PCP. They can refer you to a specialist to find the cause and the best treatment plan.

POTS Symptoms and Diagnosis

POTS causes a range of symptoms that can vary from person to person.

Many people have only mild to moderate symptoms that have no effect on their daily lives. In some cases, symptoms can go away on their own or improve with treatments.

But for some people, symptoms can get worse over time and are severe enough to impact their quality of life.

About 25% of people who have POTS suffer disabling symptoms.

POTS symptoms

Some of the most common symptoms include:

  • An increase in your heart rate upon standing.
  • Heart palpitations.
  • Lightheadedness.
  • Fatigue.
  • Headaches.
  • Exercise intolerance.
  • Nausea or vomiting.
  • Trouble concentrating.
  • Shaking.
  • Sweating.
  • Fainting.
  • Shortness of breath.
  • Cold or pain in your hands and feet.
  • Red or purple color in your legs after standing for a long time, which improves after sitting or lying down.

Your symptoms may worsen if you have to stand for a long time or haven't had enough to drink. Some women report that their symptoms worsen before their period.

Talk to your doctor if you have severe symptoms or often feel like you might faint.

Diagnosing POTS

Your doctor may diagnose you with POTS based on your symptoms and testing.

Your doctor will check your blood pressure and heart rate while lying down and then standing for two, five, and 10 minutes.

In people with POTS, we often see the following responses:

  • An increased heart rate of at least 30 beats per minute upon standing.
  • Heart rate increases to 120 beats per minute within the first 10 minutes after standing.
  • An absence of orthostatic hypotension (low blood pressure) after standing.

Other tests to help confirm a POTS diagnosis include:

  • A tilt-table test. In this test, you lie flat on a special table with safety straps to hold you in place. It measures your heart rate and blood pressure as the table slowly tilts you from a lying to a standing position.
  • An EKG. This non-invasive test can check the electrical signals in your heart.
  • A Valsalva maneuver. This breathing technique can help your doctor see if you have an autonomic nervous system problem.
  • An echocardiogram. This ultrasound of the heart checks for any problems with the heart muscle or heart valves.
  • Blood or urine tests. These tests rule out diseases that may mimic POTS.

POTS Treatment

There's no one-size-fits-all treatment for POTS. Instead, your doctor will plan your treatment around your symptoms.

The heart and vascular specialists at the UPMC Heart and Vascular Institute will work with you to help lessen and control your symptoms.

Lifestyle changes to manage POTS

Often, changes to your diet and lifestyle will effectively treat POTS.

Your doctor may advise you to:

  • Increase your fluid intake to improve your blood volume.
  • Add extra salt to your diet to help retain more fluid.
  • Eat a healthy diet to keep your heart and blood vessels healthy.
  • Wear compression stockings to help constrict blood vessels in your legs and push blood up to your heart.
  • Reduce activities that trigger POTS symptoms, such as standing for long periods or sitting with your legs crossed.
  • Engage in routine exercise that you can do in a reclined position, such as swimming or riding a recumbent bike.

Medicine to treat POTS

Your doctor may also prescribe drugs to help manage POTS that:

  • Slow your heart rate and reduce the effects of adrenal hormones on your heart.
  • Increase your fluid volume.
  • Help your kidneys retain more sodium (salt) and thus have more volume.
  • Improve the way your blood vessels constrict.
  • Treat any underlying health condition that causes POTS symptoms.