Postural Orthostatic Tachycardia Syndrome (POTS): Symptoms, Causes, and Treatment

Postural Orthostatic Tachycardia Syndrome (POTS) is a chronic condition affecting the autonomic nervous system, often resulting in a rapid increase in heart rate upon standing. This condition leads to symptoms like dizziness, chest pain, and brain fog, significantly impacting the lives of POTS patients.¹ In this blog post, we will explore the causes, symptoms, and treatment options for POTS. Wondering if you might have POTS, but not certain? Take our free self-assessment.

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What is Postural Orthostatic Tachycardia Syndrome (POTS)?

POTS is a form of orthostatic intolerance, meaning the body struggles to regulate blood pressure and heart rate when shifting from lying down or sitting to standing.² The autonomic nervous system, which controls involuntary bodily functions like blood vessel constriction and heart rate, is impaired in POTS patients. As a result, more blood often pools in the lower extremities when standing, causing the heart to compensate by increasing its rate, often to tachycardia—a heart rate above 100 beats per minute.³

POTS Symptoms and Diagnosis

POTS manifests differently for each patient, with symptoms ranging from mild to severe. Common POTS symptoms include:

• Tachycardia (increased heart rate)
• Dizziness and lightheadedness
• Fainting
• Chronic fatigue or a diagnosis of chronic fatigue syndrome
• Brain fog, which affects cognitive function and memory.⁴
• Chest pain and heart palpitations
• Orthostatic hypotension (a sudden drop in blood pressure upon standing).⁵
• Severe sweating or overheating
• Difficulty regulating temperature (hot and cold)
• Difficulty sleeping
• Bloating, belly pain, nausea, vomiting

Diagnosing POTS

Diagnosis typically involves a tilt table test, where the patient’s heart rate and blood pressure are monitored while transitioning from lying down to a standing position. An increase in heart rate of 30 beats per minute or more (40 for adolescents) within 10 minutes of standing without a significant drop in blood pressure confirms a POTS diagnosis.⁶ Blood tests may also be conducted to check for underlying conditions such as autoimmune diseases or hypovolemia (low blood volume) that can contribute to POTS symptoms.⁷

What Triggers POTS?

Many factors can trigger POTS symptoms, including viral illnesses, physical trauma, and autoimmune disorders.³ Some patients develop POTS after a significant event, such as pregnancy, surgery, or a severe infection.¹ Chronic conditions of autoimmune disease like systemic lupus erythematosus or thyroid disorders are also associated with POTS.²

How is POTS Treated?

While there is currently no cure for POTS, various treatment strategies can help manage and reduce symptoms. POTS treatment typically involves lifestyle modifications, medications, and, in some cases, physical therapy.

Lifestyle Modifications

Increasing salt intake and consuming small and frequent meals can help maintain blood volume and prevent blood pooling in the legs.⁶ Staying hydrated is also critical, and some patients benefit from salt tablets or sports drinks to help expand blood volume. Exercise training interventions, particularly recumbent exercises like cycling or swimming, have been shown to improve blood flow and reduce symptoms over time.⁸ Patients are also encouraged to avoid prolonged standing and take breaks when necessary.

Medications

Several medications can be used to treat POTS. Beta-blockers can help reduce heart rate and manage tachycardia, while fludrocortisone may help increase blood volume by promoting salt retention.⁴ Some patients with neuropathic POTS may require medications to address nerve-related issues.³ In more severe cases, medications that help constrict blood vessels and raise blood pressure may be necessary to improve symptoms.⁷ Medications are typically tailored to the individual based on the specific subtype of POTS and the severity of symptoms observed.

Brain Retraining

Brain retraining is emerging as a complementary approach to managing POTS symptoms. Brain retraining involves targeting the brain’s neuroplasticity—the ability to reorganize itself by forming new neural connections. By rewiring maladaptive pathways within the autonomic nervous system, brain retraining aims to improve the body’s response to chronic orthostatic intolerance and reduce symptoms such as tachycardia, brain fog, and chronic fatigue.⁴ Techniques like mindfulness, meditation, and visualization exercises help calm the autonomic nervous system and decrease symptom severity.

Preliminary research has shown that brain retraining programs may assist in restoring balance to the nervous system, reducing the fight-or-flight response often exacerbated in POTS patients.¹ While more research is being done to fully understand the efficacy of brain retraining in POTS treatment, many patients report improvements in their physical and mental well-being through this approach.² Brain retraining offers a hopeful, proactive way to manage the chronic symptoms of POTS and improve overall quality of life.

Living with POTS

While living with POTS can be challenging, many patients find significant improvement in their symptoms with the right combination of treatments. Early diagnosis, consistent medical management, and lifestyle changes can significantly improve the quality of life for those affected by orthostatic tachycardia syndrome.² Additionally, ongoing research and clinical autonomic research continually advance our understanding of POTS, offering hope for more effective treatments in the future.

Ways to Practice Self-Care for POTS

If you have POTS, taking care of yourself involves more than just physical management. In addition to staying hydrated, increasing salt intake, and engaging in low-impact exercises like cycling or swimming,⁶,⁸ monitoring your diet and sleep quality to maintain overall health is essential. Seek support from loved ones, and consider joining a support group or online community to connect with others who understand your condition. Mindfulness and breathwork can help calm your autonomic nervous system and reduce symptoms. Working with a chronic illness coach or a mental health counselor can also provide valuable emotional support and coping strategies.¹

There is Hope for POTS Sufferers

Postural Orthostatic Tachycardia Syndrome is a complex and often misunderstood condition, but with the right treatment approach, symptoms can be managed, and patients can regain a sense of control over their lives. Through lifestyle changes, medication, brain retraining, and supportive care, many POTS patients can improve their quality of life and navigate their condition with hope and resilience.

At re-origin, we have helped thousands of people suffering from chronic health conditions learn to regulate their nervous system and retrain their brain for healing. If you’re ready to begin your healing journey with re-origin, learn more about our program here.

References

1. Raj, S. R. (2013). Postural tachycardia syndrome (POTS). Circulation, 127(23), 2336-2342. https://doi.org/10.1161/CIRCULATIONAHA.112.144501
2. Grubb, B. P., Karas, B., & Kanjwal, K. (2020). The postural tachycardia syndrome: When to consider it and how to treat it. Cleveland Clinic Journal of Medicine, 87(4), 241-253. https://doi.org/10.3949/ccjm.87a.19092
3. Freeman, R., Wieling, W., Axelrod, F. B., Benditt, D. G., Benarroch, E., Biaggioni, I., … & Kaufmann, H. (2011). Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope, and the postural tachycardia syndrome. Autonomic Neuroscience, 161(1-2), 46-48. https://doi.org/10.1016/j.autneu.2011.02.004
4. Arnold, A. C., Haman, K., Garland, E. M., & Raj, S. R. (2022). Postural orthostatic tachycardia syndrome: Diagnosis, physiology, and prognosis. Autonomic Neuroscience, 236, 102869. https://doi.org/10.1016/j.autneu.2021.102869
5. Raj, S. R., Fedorowski, A., & Sheldon, R. S. (2018). Orthostatic hypotension and syncope in POTS patients. Journal of Clinical Autonomic Research, 28, 171-180.
6. Benarroch, E. E. (2012). Postural tachycardia syndrome: A heterogeneous and multifactorial disorder. Mayo Clinic Proceedings, 87(12), 1214-1225. https://doi.org/10.1016/j.mayocp.2012.08.013
7. Sheldon, R. S., Raj, S. R., Rose, M. R., & Guzman, J. C. (2015). Hypovolemia and treatment options in patients with postural tachycardia syndrome. Journal of Clinical Autonomic Research, 25, 353-358.
8. Fu, Q., Vangundy, T. B., Shibata, S., Auchus, R. J., Williams, G. H., & Levine, B. D. (2010). Exercise training versus propranolol in the treatment of the postural orthostatic tachycardia syndrome. Hypertension, 56(6), 1210-1216. https://doi.org/10.1161/HYPERTENSIONAHA.110.161877