Postural orthostatic tachycardia syndrome (POTS) affects one to three million Americans, but is more common in women and more likely to develop in adolescents and young adults, according to John Hopkins Medicine.
Arash Karnama, D.O., FACC, is a cardiologist with OSU Medicine. He explains that POTS is a condition that affects the autonomic nervous system, which regulates heart rate, blood pressure and circulation.
“Patients with POTS often experience symptoms when moving from sitting or lying down to standing – and it’s much more than simply feeling dizzy,” says Karnama. “For many patients, it can significantly affect school, work, exercise and quality of life.”
Common symptoms can include dizziness, lightheadedness, rapid heartbeat, fatigue, brain fog, exercise intolerance, nausea, headaches and, in some cases, fainting. Patients also often report feeling exhausted after routine daily activities. Diagnosis of POTS typically involves a detailed medical history, physical exam and monitoring heart rate and blood pressure with position changes. A common diagnostic tool is a tilt table test or an active standing test.
“In general, patients with POTS experience a significant increase in heart rate within 10 minutes of standing without a major drop in blood pressure,” says Karnama. “Because symptoms can overlap with anxiety, chronic fatigue and other conditions, POTS is sometimes misunderstood or overlooked. Recognition and proper evaluation are important so patients can receive appropriate care.”
At this time, there is no single known cause for POTS but the condition may develop for several different reasons, says Karnama. Symptoms may begin after a triggering event such as a viral illness, surgery, pregnancy, concussion or another physical stressor. Also, patients may have an underlying autonomic nervous system dysfunction or issues related to blood circulation, deconditioning or autoimmune-related conditions. While there is ongoing research to discover why women are more impacted, hormonal and immune-related factors may play a role.
Karnama says researchers have also observed an increase in POTS diagnoses following COVID-19 infections.
“Many patients can pinpoint a time when their symptoms started,” he says.
Common triggers that can worsen symptoms include dehydration, heat exposure, prolonged standing, illness, lack of sleep and intense physical exertion. Stress and hormonal fluctuations can also contribute to symptom flare-ups. To better understand triggers, since they vary from person to person, patients are encouraged to try and identify patterns and repeat catalysts.
Treatment for POTS is highly individualized, says Karnama, and often involves a combination of lifestyle modifications, physical conditioning and, in some cases, medication.
“The goal is to improve symptoms and help patients return to normal daily activities,” he says. “Initial treatment frequently focuses on increasing fluid and salt intake, improving sleep habits and avoiding known symptom triggers. Compression garments may also help improve circulation.”
Exercise therapy, particularly programs that gradually build cardiovascular endurance and lower-body strength, is considered one of the most effective long-term strategies. For more severe cases, medication may help regulate heart rate, blood pressure or fluid balance.
Adolescents and younger patients sometimes see improvement over time, while adults may require longer-term symptom management. A multidisciplinary team approach, involving cardiologists, primary care physicians, physical therapists and other specialists is often what’s recommended based on the patient’s individual needs.
“Although POTS can be frustrating and disruptive,” says Karnama, “many patients improve with a structured treatment plan and ongoing support.”
