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Postural Orthostatic Tachycardia Syndrome (POTS): Symptoms & Risk Factors

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Last updated December 9, 2022

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Care Plan

1

First steps to consider

  • Always see a healthcare provider if you have symptoms of POTS, which include lightheadedness, fainting, and increased heart rate when you stand up after sitting or lying down.

Emergency Care

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Go to the ER if you have any of these symptoms:

  • Chest pain that is worse with activity or does not improve after several minutes of rest
  • Shortness of breath that does not go away quickly with rest
  • Dizziness that does not improve after several minutes

What is POTS?

Postural orthostatic tachycardia syndrome (POTS) is a disorder that affects your blood flow, especially when standing. Symptoms usually occur when you stand up after sitting or lying down and can include lightheadedness, dizziness, increased heart rate, and fainting (syncope).

POTS causes blood to pool in the legs, which reduces the amount of blood that is sent back to the heart and pumped to the brain. Pooling may be from poorly functioning nerve signals that send blood back to the heart or signals in the heart that tell it to beat faster than necessary.

POTS is not a life-threatening condition, but it can disrupt your life. Treatment may include exercising, drinking enough fluids, having an adequate amount of salt, and taking medication.

Symptoms

One of the most common symptoms of POTS is lightheadedness. It can sometimes be so severe that it leads to fainting. Other symptoms of POTS include:

  • Heart palpitations (sensations of a fast heartbeat)
  • Fatigue
  • Shortness of breath
  • Increase in heart rate of at least 30 beats per minute when changing positions, usually within 10 minutes of standing up
  • Bluish or purple color in both feet and ankles caused by pooled blood
  • Decreased ability to exercise and do other physical activities
  • Difficulty sleeping

Causes

The exact cause of POTS is not known, but symptoms may be related to a couple of issues. One is peripheral denervation, or poor signaling along nerves that connect the brain and lower half of the body. Another is an increase in levels of hormones that tell your heart to pump faster, including epinephrine and norepinephrine. Or it may be because of low blood volume.

Problems that can bring on or worsen POTS symptoms are dehydration and not getting enough salt. Both contribute to low blood volume.

There are several other conditions and medications that may cause POTS, including:

  • Autoimmune diseases (lupus, hypothyroidism, celiac disease, etc.)
  • Alcoholism
  • Chemotherapy
  • Medications like antidepressants and diuretics
  • Very poor fitness level

Risk factors

POTS can affect anyone, but it most often affects women ages 15–50, according to a 2019 study in the Journal of Internal Medicine. Other risk factors include:

  • Pregnancy
  • Recent viral infection (like COVID or the flu)
  • Recent traumatic injury

Next steps

See a healthcare provider if you have signs of POTS. When you feel symptoms coming on, you should immediately find a safe place to lie down until they go away. It may take several seconds to a couple minutes for symptoms to stop. Lying down relieves lightheadedness by helping the blood return to the heart and get pumped to your brain.

Treatment

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