Understanding POTS: When Standing Up Becomes a Struggle

Have you ever stood up quickly and felt your heart race or your head spin for a moment? For most people, this sensation fades quickly. But for those with Postural Orthostatic Tachycardia Syndrome (POTS), these symptoms happen frequently—and they don’t go away so easily.

What Is POTS?

Postural Orthostatic Tachycardia Syndrome (POTS) is a type of dysautonomia, which means it's related to a malfunction of the autonomic nervous system—the system responsible for things we don’t consciously control, like heart rate, blood pressure, and digestion.

In POTS, the key problem is that the heart rate increases significantly when a person stands up, often by 30 beats per minute (bpm) or more in adults, or 40 bpm in adolescents, within 10 minutes of standing, without a significant drop in blood pressure. This sudden increase can cause symptoms such as:

Dizziness or lightheadedness
Palpitations (feeling your heart racing)
Fatigue
Brain fog (trouble concentrating or thinking clearly)
Nausea
Fainting or near-fainting

These symptoms can be debilitating and significantly impact daily life.

What Causes POTS?

The exact cause isn’t always known, but POTS can be triggered by:

Viral infections
Physical trauma or surgery
Prolonged bed rest
Autoimmune conditions
Hormonal changes, especially in teenage girls or young women

It's more common in females between the ages of 15 and 50, though anyone can develop it.

Diagnosing POTS

A diagnosis is often made using a tilt table test or an active standing test, where heart rate and blood pressure are monitored while a patient moves from lying down to standing. A significant heart rate increase, along with chronic symptoms, may confirm the diagnosis.

Typical Treatment Plan for POTS

There is no one-size-fits-all cure for POTS, but a combination of lifestyle changes, medications, and supportive therapies can help manage symptoms.

1. Lifestyle Changes

Increase fluid and salt intake: This helps expand blood volume and maintain blood pressure.
Compression garments: Wearing compression stockings can reduce blood pooling in the legs.
Exercise: A carefully guided exercise program (usually starting with recumbent or seated exercises) can improve circulation and build tolerance.
Elevate the head of the bed: Sleeping with the head raised can help regulate blood pressure overnight.

2. Medications

Treatment may involve:

Beta blockers (e.g., propranolol) to control heart rate
Fludrocortisone to increase blood volume
Midodrine to help raise blood pressure
Ivabradine (used off-label) to slow the heart rate without lowering blood pressure

The right medication plan depends on each individual’s symptoms and underlying causes.

3. Supportive Therapies

Physical therapy: To build tolerance for upright activities
Cognitive behavioral therapy (CBT): Helpful in managing the emotional stress that can accompany chronic illness
Dietary support: Focus on small, frequent meals and avoiding high-carb foods that may worsen symptoms

Living with POTS

While POTS can be frustrating and life-altering, many people improve over time, especially with early diagnosis and a personalized care plan. Managing POTS is a marathon, not a sprint—but with education, support, and the right care team, patients can learn to live well with the condition.

Have you or someone you know been diagnosed with POTS? Share your story or tips in the comments below—your insight could help someone else on their journey.

Understanding POTS: When Standing Up Becomes a Struggle