Managing POTS

There is no cure for POTS, but it can be treated. It’s usually managed with a combination of lifestyle changes and sometimes medications. What works well for one person may not for another, so it’s important to find what works for you. 

Most treatments aim to improve circulation, help more blood return to the heart, support heart health, and ease symptoms when you’re upright. And the goal isn’t just to improve numbers like heart rate. It’s to help you feel better and do more of the activities you enjoy. 

Because POTS affects multiple systems in your body, your care team may be made up of different specialists. For example, you may see a cardiologist (heart), a neurologist (brain and nervous system), an electrophysiologist (heart rhythm issues), a rheumatologist (musculoskeletal and connective tissue), and a gastroenterologist (digestive system), among others. These specialists should coordinate and map out the best treatment plan for you. 

Lifestyle and self-care 

• Drink more fluids, usually 2-3 liters of water a day, but check with your care team. You can always spice up your water by adding electrolytes (without added sugar) or watermelon, lime, pineapple or cucumber.
• Increase salt (sodium) intake – usually an extra 2 teaspoons, if recommended. Making sure you are well hydrated and consuming more salt can help increase blood volume.
• Wear compression garments, ideally one that wraps around the waist or abdomen when you are upright to help push blood up and return to the heart.
• Get moving and avoid long periods of standing or walking as a form of exercise – being physically active can help improve circulation, strengthen your heart health, ease symptoms, and make everyday activities easier over time. Talk with your care team about exercises that are right for you. In general, it’s important to:
  • Start gradually and increase activity over time.
  • Begin with exercises that are horizontal to the ground, such as rowing, recumbent cycling and swimming.
  • Build up slowly and ask when you might add upright activities as your symptoms improve.
  • Avoid sudden posture changes.
  • Share any concerns or symptoms that worsen with activity.
• Prioritize sleep – aim to get 7-8 hours of sleep a night. It may be helpful to elevate the head of your bed by 4-6 inches. Good sleep helps your body manage symptoms.
• Be careful during extreme heat and try not to get overheated, since heat can make symptoms worse.
• Manage stress, which can worsen symptoms.
• Eat smaller, lighter meals and limit alcohol or don’t drink it.

Medications

Medications can be helpful to ease symptoms of POTS for some people. They do not cure POTS, but they may help reduce symptoms and improve daily function. These include medications that help:

• Slow your heart rate
• Increase blood volume and “fill the tank”
• Tighten blood vessels to push more blood back up to the heart

Your care team may also recommend more fluids or salt when appropriate for you.

Other medications may be recommended to treat other conditions. These may help reduce POTS symptoms too.

The right medication depends on your symptoms, blood pressure, heart rate, other health conditions, and how you respond to treatment.

Seek ongoing care and peer support

Living with POTS isn’t easy. It’s important to keep any follow up visits, report any worsening or new symptoms and find the support you need. Here are some things that have helped others: 

Find a health care professional you trust – POTS is often misunderstood and can greatly affect daily life, so having a clinician who understands the condition and takes you seriously is important. 

Keep regular follow-up visits – your treatment plan may need to be changed over time as your goals or symptoms change. 

Know that many patients have felt dismissed – people often spend years seeking answers and are sometimes told their symptoms are “just anxiety.” If you feel as though your symptoms are not being heard or understood, keep speaking up and asking questions. POTS is a real medical condition and help is available. 

Connect with others affected by POTS – talking with people who share similar experiences can help you feel validated and less alone. It also gives you a chance to find out what questions they had along the way to help guide conversations with your care team. 

Learn about the condition – understanding POTS can help you advocate for yourself and feel more confident in conversations with your health care team. 

Speak up about your symptoms – share what makes your symptoms better or worse, and if you have any concerns.

Remember POTS is real and treatable.