Postural orthostatic tachycardia syndrome (POTS) is a form of autonomic dysfunction. This condition is more widespread than many realise, but may be met with diagnostic challenges as there is no single definitive POTS test and the condition is still not fully understood. Despite this, a specialist in POTS can make a diagnosis and provide effective treatment to manage symptoms and restore your quality of life.
POTS is part of a group of conditions known as dysautonomia, or autonomic dysfunction. These conditions are characterised by a dysregulation of the body’s autonomic nervous system, which manages all the functions under automatic control, such as heart rate, digestion, blood pressure, and temperature regulation. POTS is not the only form of dysautonomia – other disorders that fall under this umbrella term include neurocardiogenic syncope and irritable bowel syndrome.
POTS is most common among females between the ages of 15-50 years old, but can affect anyone of any age. It involves orthostatic intolerance, meaning that symptoms are brought on by standing upright and, subsequently, are relieved by lying down. This is due to a dysregulation of blood flow, resulting in a drop in blood and oxygen to your brain upon standing, leading to the classic POTS symptoms of lightheadedness and rapid heart rate.
When individuals without POTS stand up, the autonomic nervous system responds to the change in posture by constricting blood vessels and increasing the heart rate, which work to maintain blood flow to the brain against the downward pull of gravity. In POTS, the autonomic dysfunction fails to react to the change in posture, and the brain no longer receives an adequate supply of oxygenated blood.
It is not well understood why the autonomic nervous system becomes dysfunctional, but the onset of POTS often appears to occur after:
The symptoms of POTS can be diverse and vary widely between individuals, lending to the difficulties in identifying this condition. The most common POTS symptom is a rapid heartbeat, known as tachycardia, that starts within 10 minutes of standing up.
Other POTS symptoms include:
POTS can also be associated with conditions such as irritable bowel syndrome, chronic fatigue, fibromyalgia, migraine, hypermobility, and anxiety/ depression. Many POTS symptoms are triggered by standing upright and resolved by sitting or lying down, but some symptoms such as brain fog may be present regardless of your posture.
POTS treatment aims to relieve your symptoms by supporting adequate blood flow to your brain when standing upright. This can involve medications or changes to your habits. Depending on your specific symptoms, effective POTS management may need a multidisciplinary team of different healthcare professionals.
A diagnosis of POTS can be confirmed with:
A POTS diagnosis is often made by combining your symptoms, medical history, tests to exclude other causes of your symptoms, and an active stand test.
Find out more about POTS testing →
Lifestyle changes are an important part of POTS management, and are often the first step to treating your symptoms. These include:
Your cardiologist may prescribe medications to directly treat the cardiovascular effects of POTS or to address specific symptoms. Drugs such as midodrine can constrict blood vessels and improve circulation to the brain, while ivabradine helps to regulate heart rate. Other medications for POTS include fludrocortisone, which increases fluid retention, and beta-blockers to manage tachycardia.
At Harbourside Cardiology, our team is dedicated to providing holistic, patient-centred care that aligns with the most recent clinical guidelines and research. We are with you every step of your health journey, providing continuity of care of all heart conditions from initial assessment through to treatment and recovery.
