(POTS) – Postural Orthostatic Tachycardia Syndrome

Intro: Postural Orthostatic Tachycardia Syndrome, commonly known as POTS, is a condition that affects the body’s ability to regulate blood flow and blood pressure. When someone with POTS stands up from a lying or sitting position, their heart rate increases rapidly, leading to various symptoms. Although there is no cure, treatments and lifestyle adjustments can help manage the symptoms and improve quality of life.

What is POTS?

Postural Orthostatic Tachycardia Syndrome: Prevalence, Pathophysiology, and Management | DrugsPOTS is a type of orthostatic intolerance, meaning it relates to the body’s position, especially standing upright. The term “Postural Orthostatic Tachycardia Syndrome” can be broken down as follows:

  • Postural: Related to the position of the body.
  • Orthostatic: Related to standing upright.
  • Tachycardia: A heart rate exceeding 100 beats per minute.
  • Syndrome: A group of symptoms that occur together.

Under normal circumstances, the autonomic nervous system keeps your heart rate and blood pressure in balance, regardless of your position. However, in people with POTS, this balance is disrupted. When they stand up, their heart rate increases significantly, leading to symptoms like dizziness, fatigue, and a rapid heartbeat.

Who is Affected by POTS?

Amazon.com: POTS Syndrome Gifts Funny Coffee Mug Postural Orthostatic Tachycardia Illness Diagnosis Sympathy Feel Better Tea Cup : Home & KitchenPOTS mainly affects women and individuals assigned female at birth, typically between the ages of 15 and 50. POTS is relatively common, affecting an estimated 1 to 3 million people in the United States. However, it can also affect men and those assigned male at birth. Certain factors can increase the risk of developing POTS, including:

  • Significant illnesses (e.g., viral infections like mononucleosis)
  • Physical trauma (e.g., head injury)
  • Surgery
  • Pregnancy
  • Autoimmune conditions (e.g., Sjogren’s syndrome, lupus, celiac disease)

How POTS Affects the Body

In a person without POTS, standing up causes gravity to pull about 10% to 15% of their blood into the lower body. The autonomic nervous system responds by releasing hormones like epinephrine and norepinephrine, which increase the heart rate and constrict blood vessels, ensuring blood returns to the heart and brain efficiently.

For individuals with POTS, excessive blood pooling in the lower body triggers an overreaction of the autonomic nervous system. Their blood vessels do not respond properly, resulting in an increased heart rate and symptoms like dizziness, fainting, and fatigue.

Symptoms of POTS

Symptoms of POTS can vary widely and may develop suddenly or gradually. They typically occur upon standing or during prolonged periods of standing. Common symptoms include:

  • Dizziness or lightheadedness
  • Fainting or near-fainting episodes
  • Heart palpitations or rapid heart rate
  • Fatigue and exhaustion
  • Brain fog, forgetfulness, and difficulty concentrating
  • Shortness of breath
  • Chest pain
  • Headaches
  • Nausea and bloating
  • Discoloration of hands and feet
  • Disrupted sleep
  • Certain conditions can worsen POTS symptoms, such as warm environments, standing for long periods, strenuous exercise, illness, and menstruation.

Causes of POTS

The exact cause of POTS is not well understood, and it is believed to have multiple contributing factors. Researchers have identified different subtypes of POTS, including:

  • Neuropathic POTS: Caused by damage to the nerves that control blood vessel constriction.
  • Hyperadrenergic POTS: Characterized by an overactive sympathetic nervous system.
  • Hypovolemic POTS: Associated with low blood volume.

There is also evidence suggesting that POTS may be an autoimmune disorder, where the immune system mistakenly attacks healthy tissue.

Diagnosing POTS

Diagnosing POTS can be challenging due to its wide range of symptoms. Healthcare providers typically use a combination of patient history, physical exams, and specialized tests to diagnose the condition. The primary test for diagnosing POTS is the tilt table test, which measures heart rate and blood pressure changes when transitioning from lying down to standing up.

Additional tests may include blood and urine tests, QSART (a test measuring autonomic nerve function), autonomic breathing tests, skin nerve biopsies, echocardiograms, and blood volume studies.

Managing and Treating POTS

While there is no cure for POTS, several treatments can help manage symptoms. Treatment is tailored to the individual’s specific symptoms and needs. Key treatment strategies include:

Exercise and Physical Activity Regular exercise and physical activity are crucial for managing POTS. Activities that are less likely to exacerbate symptoms, such as swimming, rowing, and recumbent bicycling, are recommended. Strengthening the core and leg muscles can also help improve symptoms. Working with an experts who have experience training clients who have the syndrome is also hugely beneficial. Our team of trainers at Repke Fitness have worked with several clients who dealt with POTS so we can help you exercise in a safe manner. Contact us at RepkeFitness.com or 410-656-2121

Diet and Nutrition Dietary changes can significantly impact POTS symptoms. Increasing fluid and salt intake can help increase blood volume, which is beneficial for individuals with the hypovolemic subtype of POTS. Eating smaller, more frequent meals can prevent symptoms from worsening after large meals. Eating anti-inflammatory foods can also be helpful and working with registered dietician or nutrition health coach is also recommended.

Medications Several medications may be prescribed off-label to manage POTS symptoms, including:

  • Fludrocortisone: Increases salt retention and blood volume.
  • Pyridostigmine: May reduce tachycardia.
  • Midodrine: Causes vasoconstriction.
  • Beta-blockers: May reduce heart rate.

Lifestyle Adjustments Other lifestyle adjustments can also help manage POTS symptoms:

  • Monitoring Pulse and Blood Pressure: Regularly checking and recording blood pressure and pulse can help track symptoms and adjust treatment as needed.
  • Managing Sleep: Prioritizing good sleep hygiene and maintaining a consistent sleep schedule can improve overall health and help manage POTS symptoms.
  • Avoiding Triggers: Identifying and avoiding triggers, such as warm environments and prolonged standing, can help prevent symptom flare-ups.

Living with POTS

Living with postural orthostatic tachycardia syndrome (POTS)Living with POTS can be challenging, but many individuals find that their symptoms improve over time with appropriate treatment and lifestyle adjustments. Open communication with healthcare providers, family, and support groups can provide valuable assistance and emotional support.


The prognosis for POTS is generally positive, with many individuals experiencing significant improvement in symptoms over time. While POTS can disrupt daily life, it does not decrease life expectancy. The primary concern is the risk of injury from fainting.


Postural Orthostatic Tachycardia Syndrome (POTS) is a complex condition that affects the autonomic nervous system, leading to a variety of symptoms when transitioning to an upright position. Although living with POTS can be challenging, a combination of exercise, dietary changes, medications, and lifestyle adjustments can help manage symptoms and improve quality of life. Understanding POTS and seeking individualized care are crucial steps in managing this condition effectively. If you or someone you know is experiencing symptoms of POTS, consult a healthcare provider for proper diagnosis and treatment. After being diagnosed and when you are ready to begin your health and fitness journey, Repke Fitness and our team of trainers is here to help. Reach out to us because we’d love to help you. 410-656-2121 or contact us at https://repkefitness.com/contact/