What are the symptoms of POTS?

You can develop POTS suddenly or it can develop gradually.

Symptoms happen immediately or a few minutes after sitting up or standing. Lying down may relieve some of the symptoms.

POTS has several possible symptoms, and they vary from person to person. Symptoms include:

• Dizziness or lightheadedness, especially when standing up, during prolonged standing in one position or on long walks.
• Fainting or near fainting.
• Forgetfulness and trouble focusing (brain fog).
• Heart palpitations or racing heart rate.
• Exhaustion/fatigue.
• Feeling nervous or anxious.
• Shakiness and excessive sweating.
• Shortness of breath (dyspnea).
• Chest pain.
• Headaches.
• Feeling sick.
• Bloating.
• A pale face and purple discoloration of your hands and feet if they’re lower than the level of your heart.
• Disrupted sleep from chest pain, racing heart rate and excessive sweating during sleep.

POTS symptoms often get worse in the following situations:

• Being in warm environments, such as in a hot bath or shower or on a hot day.
• Standing frequently, such as when you’re waiting in line or shopping.
• Participating in strenuous exercise.
• When you’re sick, such as from a cold or an infection.
• Having your period (menstruation).

What causes POTS?

Researchers aren’t sure yet what exactly causes POTS. Currently, they think there are multiple causes, which they’ve grouped into different subtypes of POTS, including:

• Neuropathic POTS: This happens when peripheral denervation (loss of nerve supply) leads to poor blood vessel muscles, especially in your legs and core (abdomen).
• Hyperadrenergic POTS: This happens when your sympathetic nervous system is overactive.
• Hypovolemic POTS: Reduced blood volume can lead to POTS. Low blood volume can cause similar symptoms that may overlap in neuropathic and hyperadrenergic POTS.

There’s also growing evidence suggesting that POTS might be an autoimmune disease, meaning your immune system attacks healthy tissue for unknown reasons.

How is postural orthostatic tachycardia syndrome (POTS) diagnosed?

POTS can be difficult for healthcare providers to diagnose due to the many symptoms that can occur over time. People with POTS may have symptoms for months to years before finally being diagnosed with the condition.

A healthcare provider will ask questions about your symptoms, medications and medical history. They’ll also perform a physical exam.

A tilt table test is the main way providers diagnose POTS. The tilt table test measures your heart rate and blood pressure as you change posture and position.

Besides the tilt table test, your provider may order other tests to help confirm a POTS diagnosis or rule out other possible causes of your symptoms, including:

• Blood and urine tests for causes of POTS and conditions that mimic POTS.
• QSART (a test that measures the autonomic nerves that control sweating).
• Autonomic breathing test (this measures your blood rate and pressure response during exercise).
• Skin nerve biopsy.

What is the treatment for postural orthostatic tachycardia syndrome (POTS)?

Unfortunately, there’s no cure for POTS. Instead, healthcare providers use several strategies to manage the symptoms of POTS. Treatment is highly individualized based on your symptoms and what works best for you.

The main forms of treatment include:

• Exercise and physical activity.
• Diet and nutrition.

Medical compression stockings can also help push blood up from your legs to reduce POTS symptoms.

Exercise and physical activity

Exercise and physical activity are key to managing POTS.

Although most people with POTS have healthy hearts, your provider may recommend a cardiac rehab program. This exercise template uses the cardiac rehab model to recondition and help improve health and manage POTS. Some of the best data for treating POTS comes from cardiac rehab.

Studies show that reclined aerobic exercise, such as swimming, rowing and recumbent bicycling, has the best results. Strengthening your core and leg muscles is also helpful.

Here are important things to know as you undergo an exercise program and other physical activities. Talk with your provider for specific instructions on these exercises.

• Practice isometric exercises: These exercises involve contracting your muscles without actually moving your body. Isometrics squeeze your muscle and push your blood back toward your heart. They’re simple to do, and you can do them lying in bed or seated. It’s a good idea to do these in bed before getting up to prepare your body for sitting and standing.
• Transition slowly with your body: Go from lying to sitting on the edge of your bed. Stay there for several minutes, allowing your body to naturally adjust to the change in position. Once you’re standing, pause and wait before walking to allow your blood pressure to adjust again. If you feel lightheaded at any point, wait for a few minutes in that position to see if it resolves. If not, then return to the prior position. Moving slowly is the key.
• Begin a modest walking program: Count how many steps you can do without causing symptoms. These steps are your initial baseline. Start with walking once a day and go a little farther in time, distance or by adding steps. If you feel good, add a second walk in the day. A simple strategy for counting steps is to do 100 to 300 steps per hour during the day. Fitness trackers can monitor steps easily. Every week or every few weeks, add more steps to your daily total.
• Practice simple yoga: Practicing basic yoga with a focus on breathing may help reduce POTS symptoms.

Diet and nutrition

Managing diet and nutrition is another important aspect of managing POTS symptoms.

If you have the hypovolemic (low blood volume) form of POTS, your healthcare provider will likely recommend increasing both your fluid and salt intake to increase blood volume.

Eating a large meal can make symptoms of POTS worse, as your body redirects a lot of blood to aid in the digestion process. Because of this, providers often recommend eating several smaller meals throughout the day instead of two or three large ones.

A nutritionist or dietitian can help you with your diet. This consult can be especially helpful if you have celiac disease or other dietary sensitivities.

General guidelines for dietary changes include:

• Increase sodium in your diet from 3,000 milligrams (mg) to 10,000 mg per day.
• Drink 2 to 2.5 liters per day of fluids. Water is the best choice.
• Eat small and frequent meals instead of a few large meals.
• Eating a diet with high fiber and complex carbohydrates may help reduce blood glucose (sugar) spikes and lessen POTS symptoms.
• Keep your nutrition balanced with protein, vegetables, dairy and fruits.
• Choose beneficial salty snacks such as broth, pickles, olives, sardines, anchovies and nuts. Don’t over-rely on snack chips and crackers for salt.
• Plan grocery store shopping using a list to make sure you pick up healthy food choices and POTS care (hydration and salty supplements). If you have low stamina, have someone help you shop and carry and put away your groceries.

• Outlook / Prognosis

  What is the prognosis for postural orthostatic tachycardia syndrome (POTS)?

  The prognosis (outlook) for POTS is generally good, although it can severely disrupt daily living. POTS symptoms may come and go for years. In approximately 80% of cases, the condition improves, but many people have residual symptoms.

  The biggest risk to people with POTS is getting hurt if they faint and fall.

  What is the life expectancy of POTS?

  People with POTS have a normal life expectancy. The condition doesn’t decrease life expectancy.

  Living With

  How do I take care of myself if I have POTS?

  Postural orthostatic tachycardia syndrome can be challenging to live with. Here are some things you can do to take care of yourself:

  • Be open and honest with loved ones about your diagnosis of POTS. Talk about your fears, hopes, struggles and challenges with the condition. Encourage the people who support you to learn more about POTS.
  • Get enough sleep and eat well to help manage stress.
  • Consider attending POTS support groups (either online or in-person). They can help reduce the feeling of being alone.
  • Be very cautious of quick solutions from nonmedical sources and people. Quick solutions usually don’t help POTS and can even cause more emotional distress.
  • Consider counseling (psychotherapy) to help you learn to cope with a chronic health condition. Counseling may help manage other coexisting mental health conditions that may negatively influence POTS.
  • Meditate or take even just a few minutes of a time-out to help reduce some of your POTS symptoms.
  • Emotions can have a significant influence on your daily life and health. Identifying them can be useful if you’re talking with a counselor or POTS support group.

  When should I see my healthcare provider about POTS?

  If standing up causes unusual symptoms, such as lightheadedness and a pounding heart rate, see a healthcare provider.

  If you have POTS, try to see a healthcare provider who specializes in POTS to get the best care. You’ll also need a primary care physician to go to for routine care and health wellness management.

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