Have you ever stood up and suddenly felt dizzy, shaky, or like your heart was beating out of your chest? For most people, this might happen once in a while. But for those living with Postural Orthostatic Tachycardia Syndrome, or POTS, it’s a regular and often life-altering experience.
POTS is a condition that can deeply impact day-to-day life, especially for young women. Despite being relatively common, it’s still underdiagnosed and often misunderstood—even by healthcare professionals. If you’ve been struggling with symptoms that don’t seem to make sense, learning about POTS could help you get one step closer to answers and relief.
What Is POTS?
POTS is a type of dysautonomia, a disorder of the autonomic nervous system—the system responsible for regulating things your body does automatically, such as heart rate, blood pressure, digestion, and temperature control.
In a healthy person, standing up causes gravity to pull some blood into the lower half of the body. To keep enough blood flowing to the brain, the autonomic nervous system reacts by narrowing blood vessels and slightly increasing the heart rate. This adjustment usually happens quickly and without you even noticing.
However, in people with POTS, the nervous system doesn’t respond properly. Instead, when standing, the heart races (often increasing by 30 beats per minute or more within 10 minutes) in an attempt to compensate for poor blood flow to the brain. This can lead to a variety of distressing symptoms—both physical and mental.
Common Symptoms of POTS
People with POTS may have a wide range of symptoms. Some are more noticeable when standing, while others are present all the time. Common symptoms include:
- Rapid heartbeat (tachycardia) when standing
- Lightheadedness or dizziness
- Fatigue, often severe and unrelenting
- Fainting or near-fainting spells
- Brain fog (difficulty concentrating, memory issues, trouble with word-finding)
- Nausea, bloating, or other digestive issues
- Shortness of breath
- Blurred vision
- Headaches
- Sleep disturbances
These symptoms can vary in severity from day to day. Many people with POTS also notice that symptoms worsen after eating large meals, exercising, standing for long periods, or being in hot environments like showers or summer weather.
Who Gets POTS?
POTS affects approximately 1 to 3 million people in the United States, though some experts believe the real number is higher. It most commonly affects:
- Women between the ages of 15 and 50
- People with a history of viral illness such as COVID-19, as part of what’s now called Long COVID.
- Those with Ehlers-Danlos Syndrome (EDS), autoimmune conditions, or chronic fatigue syndrome (ME/CFS)
Getting a Diagnosis
Because the symptoms of POTS overlap with many other conditions—and because it’s not widely understood—many patients go years without a diagnosis. In fact, research shows that the average time to diagnosis is around four to five years.
To be diagnosed with POTS, a doctor, like myself, skilled in diagnosing POTS and other dysautonomias will usually:
- Take a detailed medical history and ask about symptoms.
- Perform a physical exam, especially looking at heart rate and blood pressure.
- Order a Tilt Table Test, which measures how your heart rate and blood pressure change when moving from lying to standing.
A key diagnostic sign in a tilt table test is a heart rate increase of 30 beats per minute or more within 10 minutes of standing, without a significant drop in blood pressure. For people under 19, an increase of 40 bpm is used instead.
Additional tests might be done to rule out other causes, such as dehydration, anemia, thyroid disorders, or heart problems.
Managing and Treating POTS
Although there’s currently no cure for POTS, many people are able to reduce symptoms and improve their quality of life through a combination of lifestyle changes, medications, physical therapy, and education.
1. Lifestyle Modifications
One of the most effective ways to manage POTS is to make adjustments to your daily routine:
- Drink more fluids – aim for 2–3 liters per day to help increase blood volume.
- Increase salt intake at the level prescribed to you by your doctor to help retain fluids and improve circulation.
- Wear compression garments as recommended by your doctor to reduce blood pooling in the legs.
- Avoid triggers such as hot environments, prolonged standing, or large meals.
- Eat small, frequent meals, especially avoiding large, carbohydrate-heavy meals.
2. Physical Therapy and Exercise
Exercise can be difficult when you’re already feeling exhausted, but studies show that a carefully designed, gradual reconditioning program can significantly help POTS patients. The key is to start slow and low—often with recumbent (lying down) exercises like rowing, swimming, or recumbent biking—and then work up to more intense activities over time.
The Levine Protocol and CHOP exercise program are two examples designed specifically for POTS patients.
3. Medications
There are no medications specifically approved for POTS, but doctors may use a few off-label drugs to manage symptoms:
- Beta-blockers (like propranolol) to slow down the heart rate
- Fludrocortisone to help the body retain salt and water
- Midodrine to tighten blood vessels and raise blood pressure
- Ivabradine to lower heart rate without affecting blood pressure
- Pyridostigmine to help improve nerve signals in the autonomic system
Medication effectiveness varies, and it often takes some trial and error to find what works best.
Living with POTS
Living with POTS can be isolating, especially because it’s often an invisible illness. You might look “normal” on the outside while battling brain fog, exhaustion, or dizziness on the inside. The unpredictability of symptoms can make school, work, and social life difficult.
That said, many people with POTS do get better, especially with proper treatment and support. For some, symptoms gradually improve over months or years. Others may live with POTS long-term but find ways to manage it and lead fulfilling lives.
Tips for Coping:
- Track your symptoms to identify patterns and triggers.
- Pace yourself and listen to your body—overexertion can worsen symptoms. There are several apps and devices that can be helpful with this.
- Connect with support groups (online or in-person) for shared experiences and advice.
- Advocate for yourself in medical settings. Bring a symptom log, research, or even a friend to appointments.
- Don’t ignore your mental health. Anxiety and depression are common in POTS patients—not as a cause, but as a consequence of living with a chronic illness. Therapy, support, and sometimes medication can help.
When to See a Doctor
If you’re experiencing unexplained rapid heart rate, dizziness, fainting, or chronic fatigue—especially if symptoms get worse when standing—it’s time to talk to a doctor. While POTS can be tricky to diagnose, getting the right label can lead to treatment, relief, and validation.
In Summary
POTS is a real and often life-altering condition, but it’s not hopeless. With the right tools, support, and persistence, many people with POTS regain control over their lives. If you think you or someone you know might have POTS, trust your instincts and seek medical help—answers are out there, and so is support. When you are ready, I would be happy to see you and help you along your journey to better health.