Your heart jumps 40 beats when you stand. Showers leave you lightheaded. You can’t stay upright long enough to cook dinner. You’ve been told you’re just out of shape, or that it’s anxiety.
Postural orthostatic tachycardia syndrome (POTS) is one of the most common forms of dysautonomia, and one of the most commonly missed.
How POTS is defined
The 2015 Heart Rhythm Society expert consensus describes POTS as:
- a sustained heart rate increase of 30 or more beats per minute within 10 minutes of standing (40 or more in people ages 12–19),
- without a significant drop in blood pressure,
- with symptoms of orthostatic intolerance lasting at least three months.
Who gets POTS
POTS most often affects women between their teens and about age 50, though anyone can develop it. It frequently begins after:
- a viral illness,
- pregnancy,
- surgery or trauma,
- concussion, or
- a period of major physical or emotional stress.
It’s associated with joint hypermobility, mast cell activation, autoimmune conditions, and small fiber neuropathy. For POTS that began after a COVID infection specifically, see our page on POTS after COVID.
Common symptoms
- Racing or pounding heart when upright
- Lightheadedness, blurred or gray vision, near-fainting
- Fatigue and exercise intolerance
- Brain fog, especially when standing or sitting upright for long periods
- Shakiness, chest discomfort, or shortness of breath when upright
- Nausea, bloating, or constipation
- Reddish-purple discoloration of the legs when standing
- Heat intolerance and poor sleep
Patterns clinicians describe
Clinicians often describe overlapping patterns, such as reduced blood volume, excess adrenaline response, or nerve involvement in the legs. These patterns aren’t formal diagnoses, and many people have features of more than one, but they can help guide what else to look for.
Why POTS is missed
Heart rate and blood pressure are usually checked while you’re sitting. EKGs, echocardiograms, and Holter monitors are often normal. The defining finding appears only when you move from lying down to standing.
How it is evaluated
- Orthostatic vital signs: an active stand test measuring heart rate and blood pressure lying down and at intervals while standing.
- A detailed history: triggers, timeline, and associated symptoms.
- Ruling out other causes: anemia, thyroid disease, dehydration, medication effects, adrenal problems, and heart rhythm disorders.
- Looking for associated conditions: hypermobility, mast cell activation, small fiber neuropathy, and autoimmune disease.
- Referral for tilt table or formal autonomic testing when needed. See autonomic testing explained.
A note on self-management
Fluids, salt, compression garments, and gradual position changes come up often in POTS discussions. They aren’t right for everyone, especially people with high blood pressure, kidney disease, or heart conditions. Talk with a clinician before making changes.
When to get emergency care
Call 911 for:
- chest pain,
- fainting during exercise or while lying down,
- palpitations followed by fainting, or
- shortness of breath at rest.
Serving Oklahoma City, Tulsa, and all of Oklahoma
Venturis Clinic sees patients from Oklahoma City and surrounding areas, including Tulsa, and from across Oklahoma. Learn more on our Dysautonomia in Oklahoma City page.
Frequently asked questions
Is POTS a heart condition?
POTS involves the heart rate, but it’s considered a disorder of the autonomic nervous system rather than structural heart disease.
Can POTS go away?
Many people improve over time, especially younger patients and those whose POTS followed a clear trigger. The course varies.
Does POTS show up on an EKG?
Usually not. The key finding appears with a standing or tilt test.
Is POTS just anxiety?
No. Anxiety can overlap with POTS, but it doesn’t explain a sustained 30-plus beat heart rate rise on standing.
Ready to find out what’s driving your symptoms? Book a free 15-minute discovery call, or learn more about dysautonomia care in Oklahoma City.
This page is for educational purposes and is not a substitute for individual evaluation.
By Alvin Philipose, DC, ICCP
Sources
- Sheldon RS, et al. 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm. 2015;12(6):e41–e63.
- Freeman R, et al. Clinical Autonomic Research. 2011;21(2):69–72.