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POTS: Understanding and Treating the Dizzying Syndrome

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POTS or Postural Orthostatic Tachycardia Syndrome is a condition that affects the autonomic nervous system, leading to an abnormal increase in heart rate. The condition is characterized by a sudden fall in blood pressure and dizziness upon standing up. People with POTS often experience a range of debilitating symptoms, including lightheadedness, fatigue, and fainting spells.

POTS affects around 1 to 3 million people in the United States. The condition primarily affects women, with over 80% of cases reported in females. POTS is often diagnosed in young adults, with most cases presenting between the ages of 15 to 50. The prevalence of POTS in the general population is unknown, but studies report a higher incidence in patients with autoimmune diseases such as lupus, Ehlers-Danlos syndrome, and Sjogren's syndrome.

Symptoms of POTS can range in severity and duration. The most common symptom is a rapid increase in heart rate upon standing up. People with POTS often experience dizziness, lightheadedness, and may even faint. Other symptoms may occur, such as:

  • Weakness
  • Blurred vision
  • Palpitations
  • Shortness of breath
  • Brain fog
  • Nausea

To diagnose POTS, your physician will begin with a physical examination and medical history. Further testing may be required, including a tilt table test and an electrocardiogram. While there is no known cure for POTS, several lifestyle changes and medications can help manage the condition.

Diagnosis of POTS

Diagnosing POTS is a complex process that requires a medical professional's expertise. The diagnostic process can take time and patience, but an accurate diagnosis is crucial to effective treatment. Here are some of the common diagnostic techniques used to diagnose POTS:

Physical examination and medical history

A physical examination of the affected individual can go a long way in diagnosing POTS. This will typically include a thorough examination of the heart, blood pressure, and nervous system. Your medical provider will ask about your symptoms and medical history, including any medical conditions you may have or medications you are taking. This information can help to rule out other medical conditions that may mimic POTS symptoms.

Tilt table testing

Tilt table testing is the most definitive test used to diagnose POTS. During tilt table testing, you will lie flat on a table, and the table will be tilted up to 70 degrees. A doctor will measure your heart rate and blood pressure to see if they change when you assume an upright position. During tilt table testing, doctors can also monitor your response to medication and determine the most effective treatment plan.

Electrocardiogram (ECG) and other tests

An electrocardiogram (ECG) is a diagnostic test that can help identify cardiac arrhythmias and other heart-related issues that may cause POTS symptoms. Other tests may include a Holter monitor, which records heart activity over a 24-hour period, or echocardiography, which uses ultrasound waves to examine your heart's structure and function.

In addition to the above-listed tests, other diagnostic tools may include blood tests to rule out autoimmune disorders or other underlying conditions that may be causing symptoms. With the information obtained from these tests, your doctor can determine an accurate diagnosis and develop an effective treatment plan to manage your POTS symptoms.

Causes of POTS

POTS is a complex condition that requires thorough investigation to diagnose its underlying cause. In many cases, the cause of POTS is not clear. However, research has shown that several factors can increase the risk of developing POTS. These include:

Autoimmune disorders

Many people with POTS have an underlying autoimmune disorder. The immune system is responsible for protecting the body against infections, but when it attacks healthy cells, it can lead to a range of health problems, including POTS. Autoimmune disorders that have been associated with POTS include:

Neurological conditions

POTS can also develop as a result of problems with the nervous system. This can include damage to the nerves or an imbalance in the chemicals that help the nervous system function normally. Neurological conditions that have been associated with POTS include:

  • Migraine
  • Ehlers-Danlos syndrome
  • Mast cell activation syndrome
  • Cerebrovascular disease
  • Small fiber neuropathy

Genetic factors

Genetics can also play a role in the development of POTS. Studies have shown that POTS may be inherited in some families, but the specific genes involved are not yet well understood. Researchers are working to identify the genes that contribute to POTS and determine how they affect the body's functions.

While the exact cause of POTS may be difficult to determine, understanding the risk factors associated with the condition can help medical professionals provide appropriate treatment. By addressing the underlying causes of POTS, doctors can help manage its symptoms and improve the quality of life for affected individuals.

Treatment of POTS

Lifestyle changes

For individuals with mild to moderate POTS symptoms, making lifestyle changes can be an effective way to manage symptoms and improve quality of life. Here are some lifestyle changes that can be helpful for managing POTS:

  • Exercise: Regular exercise, such as walking or cycling, can increase blood flow, improve blood pressure, and strengthen the muscles. However, individuals with POTS should start slowly and gradually increase the intensity of their exercise regimen to avoid exacerbating symptoms.
  • Dietary changes: Eating a diet rich in whole foods and low in processed foods can help manage POTS symptoms. Drinking plenty of fluids, especially water, can also help maintain blood pressure and prevent dehydration.
  • Avoiding triggers: Identifying triggers that worsen POTS symptoms, such as heat or standing for long periods, can help individuals manage their symptoms. Avoiding these triggers can help prevent episodes of dizziness or fainting.

Medication therapy

In some cases, lifestyle changes alone may not effectively manage POTS symptoms. Medications can help control symptoms and improve quality of life. Some common medications used to treat POTS include:

  • Beta blockers: These medications slow the heart rate and reduce the workload on the heart, which can help control heart rate and blood pressure. Beta blockers are typically used as first-line treatment for POTS.
  • Fludrocortisone: This medication helps retain salt and fluid, which can help increase blood volume and improve blood pressure. This medication may be prescribed in combination with other medications.
  • Midodrine: This medication helps constrict blood vessels, which can help raise blood pressure and reduce symptoms such as dizziness or fainting.

Other treatments

In addition to lifestyle changes and medication therapy, there are other treatments that may be helpful for managing POTS symptoms, including:

  • Compression stockings: These specially designed stockings apply pressure to the legs, which can help improve blood flow and reduce symptoms such as leg swelling or pain.
  • Intravenous saline therapy: This treatment involves receiving fluids through a vein in the arm, which can help increase blood volume and improve blood pressure.
  • Physical therapy: A physical therapist can teach exercises and techniques to manage symptoms, such as deep breathing and relaxation exercises. Physical therapy can also help with muscle strengthening and conditioning.

It is important to work with a healthcare provider to determine the best course of treatment for POTS. Treatment may involve a combination of lifestyle changes, medications, and other treatments, depending on the severity of symptoms and underlying causes. With proper management, individuals with POTS can lead fulfilling lives and achieve their goals.

Management of POTS

Living with POTS can be challenging and may require ongoing management. Here are some key aspects of managing POTS:

Long-term care

POTS is a chronic condition that typically requires long-term care. It is important for individuals with POTS to work closely with their healthcare provider to develop a management plan that meets their unique needs. This plan may involve a combination of lifestyle changes, medications, and other treatments, as well as ongoing monitoring and follow-up appointments with healthcare professionals.

Follow-up appointments with doctors

Regular follow-up appointments with healthcare providers are an essential part of managing POTS. These appointments allow for monitoring of symptoms and adjustments to treatment as needed. It is important for individuals with POTS to communicate any changes in symptoms or concerns with their healthcare provider in a timely manner.

Potential complications

While POTS itself is not typically life-threatening, it can lead to complications if not properly managed. Complications may include fainting, dehydration, and falls. It is important for individuals with POTS to take steps to prevent these complications, such as avoiding triggers, staying hydrated, and using assistive devices if needed.

In addition to physical complications, living with POTS can also have a significant impact on mental health and well-being. It is important for individuals with POTS to seek support from loved ones, mental health professionals, or support groups as needed.


POTS can be a challenging condition to navigate, but with proper management and support, affected individuals can still lead fulfilling lives. Here's a summary of key points covered in this article:

  • POTS is a condition characterized by dizziness, lightheadedness, and other symptoms upon standing.
  • Diagnosis often involves physical examination, tilt table testing, and other medical tests.
  • The underlying causes of POTS are not fully understood but may be related to autoimmune disorders, neurological conditions, or genetic factors.
  • Treatment options for POTS include lifestyle changes such as exercise and dietary modifications, medications such as beta blockers and fludrocortisone, and other therapies such as compression stockings and physical therapy.
  • Management of POTS requires long-term care, regular follow-up appointments with healthcare providers, and taking steps to prevent potential complications such as fainting and dehydration.
  • Ongoing research is being conducted to better understand POTS and develop new treatment options.

If you are affected by POTS, know that you are not alone. There are numerous resources available to help you manage your symptoms and live a fulfilling life. Talk to your healthcare provider and seek out support from loved ones or support groups. With the right management plan and mindset, POTS does not have to hold you back.

William H. McDaniel, MD

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School.

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