POTS

When to see a healthcare provider

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

While POTS is not a life-threatening condition, it is important to try to reduce symptoms, especially if you’re prone to fainting, which can lead to injuries. Your provider will want to make sure you don’t have other conditions with similar symptoms, like anemia and myocarditis.

Getting diagnosed

Your provider can usually diagnose POTS based on your symptoms, medical history, and the results of tests like:

• The tilt table test is the most accurate way to diagnose POTS. You lie on an inclined table and the provider monitors your blood pressure as the table tilts upward.
• Monitoring your blood pressure while you sit, stand, and lie down. You may also be sent home with a monitoring device to measure your blood pressure for a 24-hour period.
• Blood tests can measure hormone levels and rule out other conditions that can cause low blood pressure, like anemia and low blood sugar.
• Tests that evaluate your heart. Your provider may order an electrocardiogram (ECG) to measure electrical activity of the heart or an echocardiogram, which shows blood flow through the heart. These tests help rule out problems with the structure of the heart and detect heart rhythm changes.
• You may be sent home with a monitor to track the electrical activity of your heart for about 1 week.

What to expect from your visit

• Your healthcare provider may recommend drinking more fluids and increasing salt in your diet to help raise your blood pressure. Try to drink about 8 to 12 cups of water and get 1½–2 teaspoons of salt daily. Good sources of sodium include table salt, sports beverages, oral rehydration salts, and some soups. Your provider may prescribe salt tablets.
• Aerobic exercise is usually recommended for people with POTS. Your provider may refer you to a physical therapist who can create a safe program for you.
• Strength training is also part of POTS treatment. Increasing strength in your legs can help reduce the amount of blood that pools in your lower extremities.
• Counseling may be recommended if living with a chronic illness like POTS is affecting your mental health.

Depending on what is causing POTS and the severity of your symptoms, your doctor may prescribe medications including:

• Fludrocortisone (Florinef Acetate), a corticosteroid that helps your body hold onto fluid
• Desmopressin (DDAVP), a synthetic hormone that also helps you retain fluid
• Midodrine (ProAmatine), a cardiovascular medication to help constrict (or tighten) the blood vessels in your legs, improving blood flow back to the heart
• The vasopressor droxidopa (Northera) to help blood vessels constrict
• A beta blocker like labetalol (Trandate) or metoprolol (Lopressor) to slow your heart rate. Pyridostigmine (Mestinon), a type of stimulant that can help support nerve signaling
• The heart drug ivabradine (Corlanor) to lower heart rate
• Methylphenidate (Concerta), a stimulant that can improve symptoms like fatigue and sensations that you are going to faint

Types of POTS providers

• A primary care provider can diagnose and treat most cases of POTS.
• A physical therapist can design an exercise program for you.
• If you have a complex case, you may be referred to a neurologist or cardiologist. These specialists have additional training in treating conditions that affect the nervous system (neurologist) and the heart and vessels (cardiologist).

How to manage POTS at home

While POTS should always be treated by a doctor, lifestyle changes are recommended to help prevent symptoms.  Your doctor may recommend that you:

• Get enough salt (about 1½–2 tsp) and drink lots of fluids (about 8–12 glasses) daily.
• Exercise for 20–30 minutes at least 3 times per week. POTS exercise programs tend to focus on leg strengthening and cardiovascular exercises. Be sure to ask your provider for exercises that are safe and effective. It can be difficult to exercise while upright, so you may want to start with aerobic exercise you can do while sitting, like pedaling a recumbent bicycle or using a rowing machine. 
• Try to be upright and active as much as possible during the day. Avoid standing still or lying down for long periods of time.
• In the morning, get up slowly from your bed. Sit up and then wait a few minutes before standing.
• Make it a habit to do movements that improve the flow of blood to the heart, like tensing your calves, crossing your legs, and shifting your weight. Doing these may temporarily relieve or lessen POTS symptoms.
• Wearing compression stockings can help return blood from the lower extremities back to the heart. These may be recommended if you have severe symptoms or if other treatments have not been helpful.