Understanding POTS: When Symptoms May Point to a Circulatory Disorder

Feeling lightheaded after standing up is something most people experience from time to time. However, if these episodes happen regularly, are accompanied by a noticeably faster heartbeat, and start interfering with everyday activities, your symptoms may point to an underlying condition. One possible cause is postural orthostatic tachycardia syndrome (POTS), a disorder that affects how the body regulates circulation when moving from lying or sitting to standing. Learning more about POTS can help individuals recognize potential symptoms, seek appropriate care, and begin managing the condition sooner.

What Is POTS?

Postural orthostatic tachycardia syndrome (POTS) is a disorder that affects the autonomic nervous system, which is responsible for regulating involuntary functions such as heart rate, blood pressure, and circulation. Each part of the name reflects an aspect of the condition:

• Postural refers to body position

• Orthostatic means standing upright

• Tachycardia is when a heart rate reaches above 100 beats per minute

• Syndrome refers to a group of symptoms that occur together

Normally, standing up causes gravity to pull blood toward the lower body. To compensate, the nervous system releases hormones that tighten blood vessels and slightly raise heart rate, keeping enough blood flowing to the brain and heart. These adjustments happen automatically within seconds, allowing most people to stand without noticing any significant changes.

In people with POTS, these automatic processes do not respond as they should when the body changes position. As a result, less blood returns to the heart and reaches the brain, and the heart begins beating much faster to maintain appropriate circulation.

Common Symptoms of POTS

POTS is most commonly associated with lightheadedness or dizziness, especially after standing, as well as rapid heartbeat or heart palpitations. Other signs of POTS include:

• Fainting or feeling as though you might faint

• Fatigue that doesn't improve with rest

• Brain fog, including difficulty concentrating or remembering information

• Shortness of breath

• Chest discomfort

• Shakiness or tremors

• Excessive sweating

• Headaches

• Nausea or other digestive symptoms

Symptoms tend to vary from person to person and may fluctuate in severity from day to day. Many people also find that their symptoms become more noticeable after prolonged standing, exposure to heat, dehydration, illness, or strenuous physical activity.

How is POTS Diagnosed

Because symptoms can differ between patients and overlap with those of other conditions, POTS can be difficult to recognize without a thorough medical evaluation. Getting an accurate diagnosis typically starts with a detailed conversation with a healthcare practitioner about symptoms, medications, and medical history, followed by a physical exam.

The primary tool used to diagnose POTS is a tilt table test. During this test, a patient lies flat on a table that is then tilted upright while their heart rate and blood pressure are monitored, allowing doctors to observe how the body responds to the position change.

Additional testing may be used to confirm a POTS diagnosis or rule out conditions that can cause similar symptoms. This may include blood or urine testing, autonomic breathing tests, which measure heart rate and blood pressure responses during exercise, or other specialized evaluations.

Treatment and Symptom Management

Although there is currently no cure for POTS, many people are able to significantly improve their symptoms through an individualized treatment plan.

For many patients, treatment begins with lifestyle modifications. Your doctor may suggest increasing fluid intake and, in some cases, consuming more sodium to help support blood volume. Many heart specialists also recommend improving cardiovascular fitness with recumbent aerobic exercises such as swimming, rowing, and recumbent bicycling. Your physician may also give you instructions for specific exercises to do before standing, to improve blood flow and help the body transition to a new position.

There are currently no medications approved by the FDA specifically for POTS, but clinicians may prescribe certain medications to target specific symptoms. These can include medications that help retain sodium, reduce heart rate, or support blood vessel constriction.

When to Seek Specialty Care

Occasional lightheadedness after standing is usually nothing to worry about, but symptoms that are frequent, disruptive, or accompanied by a rapid heartbeat are worth discussing with a cardiologist. Because POTS can resemble other conditions, a proper evaluation is the best way to understand what's causing your symptoms and find a treatment approach that works.

Cardiologists, particularly those who specialize in cardiac electrophysiology, are often involved in diagnosing and managing POTS. With the right care team, most people with POTS can manage their symptoms and maintain their daily routines. If you're experiencing symptoms that may point to POTS, our specialists at Florida Cardiovascular Partners can help evaluate your symptoms and guide you toward an appropriate care plan. Contact us today to learn more.