Understanding Postural Orthostatic Tachycardia Syndrome (POTS)

POTS (postural orthostatic tachycardia syndrome) is a condition where your heart rate increases too much when you move from a lying to standing position or when you stand for long periods. When this happens, you may feel very unwell. You might notice your heart racing, or feel lightheaded, shaky, or short of breath with standing – whether you’re walking, standing in line, shopping, or even cooking. 

POTS has many causes and affects multiple systems in your body, including your autonomic nervous system. This is the part of your nervous system that controls functions like heart rate, breathing, digestion, and temperature – things you usually don’t have to think about.  

What happens in the body

When you stand, gravity pulls blood toward your abdomen and legs. Normally, your body automatically adjusts to this change in position. For example, by tightening blood vessels, returning blood to the heart and keeping your heart rate steady. 

If you have POTS, several things happen when you stand: 

• Blood pools in the lower body.
• Not enough blood returns to the heart, so your heart pumps less blood with each beat.
• To try to keep up with the body’s needs and keep blood flowing, the heart speeds up, beating much faster than normal (this is called tachycardia).

 How fast? In adults, heart rate can jump by 30 beats per minute or more within 10 minutes of standing (normally the change is only a few beats per minute). In children and teens, the increase in heart rate is often 40 beats or more per minute. With POTS, blood pressure usually stays fairly steady. 

POTS is a real medical condition – it’s not just “in your head,” and treatments can make a meaningful difference.

Who is affected

People with POTS will often feel unwell when they stand, which helps set it apart. It’s different from when someone might feel faint, dizzy or lightheaded upon standing and the feeling passes quickly or only happens occasionally. 

POTS is more common in younger people, especially women. And it often strikes people who were previously active and healthy. 

• About 85% of people with POTS are women.
• Most people develop POTS between 12 and 50 years of age.
• Many patients say their symptoms are initially dismissed as anxiety.

Why speaking up matters

Without treatment, POTS often interferes with daily activities, relationships, work, school, and ability to exercise. The good news is that many people improve with treatment and can get back to doing more of the things that matter to them. Still, because POTS is not well understood, many people can feel misunderstood and dismissed. It’s important to share any concerns with your health care team. 

Connecting with others who have POTS or care for someone who does can also be very helpful. It’s important to speak up about how you’re feeling and learn how to advocate for yourself to get the care you deserve. 

Read on to learn more about what POTS feels like, how it’s diagnosed, how it’s treated, and what questions you might want to ask your care team, as well as additional resources to help you along your journey.