What is postural orthostatic tachycardia syndrome (POTS)?

Postural orthostatic tachycardia syndrome (POTS) is a health condition that causes dizziness and a fast heartbeat when you stand up, as well as a range of other symptoms. It can make daily activities very difficult.

It is caused by a problem with your autonomic nervous system. This is the part of your nervous system that controls body functions that happen automatically, without you needing to think about them, such as your heartbeat, blood pressure, body temperature and digestion.

POTS can affect people of any age, but it is more common in adolescent and young adult females.

What are the symptoms of POTS?

The main symptom of POTS is feeling unwell with a fast heartbeat and other unpleasant sensations when you stand up. The symptoms usually go away if you lie down.

When standing, you might:

• feel dizzy, nauseous or lightheaded
• become tired or shaky
• faint
• have chest pain, palpitations, blurred vision or headache

You might also have symptoms that are not related to standing, such as:

• tiredness and sleep problems
• pain, especially in your head, neck and shoulders
• difficulty with thinking
• problems with passing urine
• bloating, constipation or diarrhoea
• feeling very sensitive to light, noise, smell or taste
• reduced ability to do intense activities

What causes POTS?

When you stand up, gravity pulls blood down into the lower part of your body, away from your brain. Your autonomic nervous system should react instantly to push the blood back up towards your heart and brain. In people with POTS, there is a problem with this process — blood doesn't get up to your brain as it should, making your heart beat faster to improve blood flow.

It's not clear why the autonomic nervous system stops working properly, but it most often happens after a viral infection, such as COVID-19 or infectious mononucleosis. Many people with long COVID have POTS.

It may also happen after:

• surgery
• hormonal changes, such as pregnancy, getting your period or menopause
• concussion or other injuries

POTS is not caused by vaccines. In fact, vaccinations may protect you from POTS, because they prevent viruses that can trigger POTS.

You are more likely to have POTS if you also have:

• migraine
• coeliac disease
• irritable bowel syndrome
• fibromyalgia
• chronic fatigue syndrome
• Ehlers-Danlos syndrome

When should I see my doctor?

Talk to your doctor if you feel unwell when you stand up or have other symptoms of POTS. The sooner you begin treatment, the more likely it will help.

How is POTS diagnosed?

Unfortunately, people often have symptoms for a long time before they are diagnosed with POTS.

Your doctor can diagnose POTS based on your symptoms and measuring your heart rate and blood pressure when you stand up. They might ask you to do an active standing test. This involves lying on your back for 5 minutes, then standing for 10 minutes. Your doctor or nurse will measure your heart rate and blood pressure before you stand up and then every minute while standing.

There is no test to confirm that you have POTS. Your doctor might arrange for you to have blood tests and some tests of your heart, to check for other causes of your symptoms.

How is POTS treated?

There is no cure for POTS, but there are treatments that can relieve the symptoms.

Here are some tips that can help:

• Drink 2 to 3 litres of water every day.
• Add salt to your food — aim for 10 to 12 grams of salt per day. Some people may need to take salt tablets.
• Limit tea, coffee, alcohol and energy drinks and large meals.
• Be as active as you can.
• Avoid hot environments and hot showers.
• Wear compression stockings.
• Try not to stand for long periods.

If you have trouble eating, you may benefit from visiting a dietitian. If you find it hard to exercise because of your symptoms, an exercise physiologist can help.

You may need to take medicines to slow down your heartbeat, increase the amount of blood in your body or help you concentrate. Some people may benefit from having fluid injected into a vein. If you need medicine, your doctor might refer you to a POTS specialist.

Depending on your symptoms, your doctor might refer you to other specialists, such as a neurologist, gastroenterologist, vascular surgeon, psychologist, or allied health professionals, such as a physiotherapist or occupational therapist.

Can POTS be prevented?

There's no known way to prevent POTS developing. However, if you have POTS, you can prevent flare-ups by avoiding things that make it worse, such as getting overheated or drinking alcohol.

Complications of POTS

POTS can make it difficult to work, study or do your usual daily activities. Around 1 in 4 people with POTS stop school or work because of their symptoms.

People with POTS may have a reduced quality of life, experiencing:

• pain
• difficulty with movement
• anxiety
• depression
• difficulty caring for themselves

Resources and support

Visit the Australian POTS Foundation for more information, support and a list of health professionals with experience in treating POTS.