Updated: 2022, Apr 20

Postural Tachycardia Syndrome (PoTS): Symptoms, Causes, & Treatment

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Postural Tachycardia Syndrome (PoTS): Symptoms, Causes, & Treatment

So, what is Postural Tachycardia Syndrome? – it’s quite complicated actually, having to do with the nervous system’s response to standing up. While there are only a couple key symptoms to watch out for and/or in diagnosing Postural Tachycardia Syndrome (also known as PoTS), it’s important to be aware of triggers that can worsen these symptoms.

One may be diagnosed with PoTS after experiencing one or most of these symptoms associated with an increase in heart rate of at least 30 beats per minute within ten minutes of standing. These symptoms can be debilitating, ranging from mild to severe and may vary from day to day.

  • Dizziness or pre-syncope (almost fainting)
  • Syncope (fainting)
  • Palpitation (awareness of heartbeat)
  • Headaches and migraine – orthostatic headaches (due to up right posture)
  • Brain Fog (difficulty in thinking)
  • Tiredness
  • Sense of anxiety
  • Shakiness
  • Visual Problems (greying, tunnel or glare)
  • Gut problems (nausea, diarrhea, pain)
  • Sweating
  • Chest Pain
  • Poor Sleep
  • Bladder Problems

Then there are the triggers to consider. One might maintain hope and vigilance while running around with this disorder until a trigger causes a symptom to flare. Watch out for the following:

  • Excess heat
  • After eating- especially refined carbs: sugar, white flour, etc.
  • Standing up quickly
  • Dehydration
  • Time of day (especially rising after wakening)
  • Menstrual Cycle
  • Deconditioning or prolonged bed rest
  • Alcohol (as it dilates blood vessels)
  • Excessive exercise
  • Temporarily during illness such as viral infections or after operations
Postural Tachycardia Syndrome Info

In diagnosing PoTS, sometimes your general practitioner will recognize the condition but in most cases a clear diagnosis is only made by an electrophysiologist (aka- heart rhythm expert), neurologist or other hospital physician. These doctors may perform some or all of the following tests to confirm a diagnosis and/or exclude other conditions with similar symptoms:

  • Active Stand Test – After resting flat for a few minutes with a heart rate and blood pressure being recorded, the patient is asked to stand up. Further recordings are taken over the ten minute period from the time the patient stands up.
  • Tilt Table Test – As is typical of all these tests, the blood pressure and heart rate will be recorded. In this test, the patent lies on a bed that (as you may have already figured) tilts, so that the scientists may record the patient’s responses after the patient has laid flat for a time, he or she is then tilted (head end up) for up to 45 minutes for further recordings.

*These tests are of course stopped if a patient faints or if satisfactory recordings are made.

Other Tests – may include electrocardiogram (ECG), blood pressure monitoring, blood tests up to and including

  • Full blood count
  • Kidney and liver function
  • Thyroid function
  • Calcium
  • Diabetes tests
  • Lying and Standing Norepinephrine Levels
  • Echocardiogram
  • Exercise test
  • Autonomic Screening Tests

* Be aware that this is considered an autonomic disease…
It is yet unknown exactly what causes PoTS in most cases. It is known to follow viral illnesses, but also linked to pregnancy and traumatic events.

There are also other conditions associated with PoTS such as follows:

  • Joint Hypermobility Syndrome
  • Low Blood Pressure
  • Chronic Fatigue Syndrome – some researchers believe there is a correlation between these two syndromes as it is estimated that PoTS affects about ? of people with Chronic Fatigue Syndrome.
  • Inappropriate Sinus Tachycardia (IST)
  • Autoimmune Conditions – Treatment of these underlying conditions that may or may not be associated with PoTS, can in fact improve the symptoms.

* Multiple Sclerosis, Pure Autonomic Failure, Multiple System Atrophy (MSA), Diabetes, Lyme Disease, Cancer and Alcoholism are all conditions believed to be associated with PoTS.

Fluids Intake

Most doctors seem to believe that lifestyle changes may actually be the cultivation of controlling symptoms. This doesn’t mean the patient is cured, just more comfortable. Here are a few things you can do to improve your condition if you are suffering from this rare yet violent condition.


  • Experts recommend 2-3 liters per day, most likely they’re expecting you to drink water. It is noted that symptoms may be worse in the morning and therefore drinking a couple glasses of water can help to elevate the dropping
  • Alcohol dilates blood vessels- making symptoms worse!
  • There are mixed opinions on coffee and other caffeinated drinks regarding worsening and/or helpful to symptoms. Beware.

Food and Salt

Who would have thought the doctors would recommend a high salt intake on a daily basis. In some cases- up to 10 grams per day.


Because one of the more prominent symptoms of this disorder is fainting, you need to take notice of early warning signs when it comes to the possibility of fainting.

  • Lightheadedness
  • Dizziness
  • Nausea

Lie down right away, elevating your legs. This should help to alleviate some of the discomfort.

Temperature Regulation

As we have discussed, heat worsens symptoms. In order to prevent overheating, try dressing in layers so that clothes can be removed. Experts recommend extra salt and fluid intake if you feel hot or sweat more often.


Wanna CURE? – get your exercise! –

It might be a long road though because initially, physical exertion can worsen PoTS symptoms so it’s important to factor in recovery time. But you might focus on leg and core strength which helps to keep the blood pumping back to the heart.

Must watch out this video

There are lists of lifestyle changes one can make to alleviate or cure symptoms of PoTS. Talk with your doctor frequently to manage your symptoms.

In some cases, medication may be recommended. It’s a tricky process because there are no drugs that have currently been licensed or approved for this use. Make sure you’re having continual conversations with your doctor depending on the severity of your symptoms and recovery.

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