What is POTS

"Postural tachycardia syndrome refers to an exaggerated increase in heart rate with standing. A healthy individual usually has a slight increase in heart rate—by about 10-15 beats per minute—within the first 10 minutes of standing.

 POTS is an abnormality in the regulation of heart rate; the heart itself is usually normal. Some patients with POTS in the first 10 minutes of upright standing or tilt testing will go on to develop NMH (neurally mediated hypotension) if the test is continued; the two conditions often are found together, and they are not mutually exclusive diagnoses. Both are capable of causing chronic, daily, orthostatic symptoms."

Dr. Peter C. Rowe, M.D., 2014

Symptoms of POTS:

  • Dizziness or light-headedness or presyncope (almost fainting)

These symptoms usually occur when standing up,  but can occur with prolonged sitting.

  • Syncope (fainting or blackouts) Approximately30 % of people with PoTS experience fainting.
  • Palpitations - Palpitations are a sensation of your heart pounding in your chest.
  • Headaches- Approximately two thirds of those with PoTS have orthostatic headaches which means they occur as a result of being upright and may be caused by reduced blood supply to the brain.  Most people with PoTS also have migraine type headaches.
  • Tiredness or weakness
  • Brain fog- Difficulty in thinking or concentrating.
  • Shakiness or Tremulousness
  • Shortness of breath
  • Chest pain
  • Excessive or patchy reduced sweating
  • Gut problems - Nausea is common. Other symptoms include diarrhoea, constipation, bloating, abdominal pain and vomiting.
  • Poor sleep - Many patients have insomnia. This can be trouble getting to sleep,  waking in the middle of the night and trouble getting back to sleep.
  • Visual problems - This can be described as excessive glare, blurred or tunnel vision.
  • Bladder problems

Courtesy of POTS UK 

Postural Orthostatic Tachycardia Syndrome (POTS)

"Postural tachycardia syndrome (POTS) is a form of chronic orthostatic intolerance for which the hallmark physiological trait is an excessive increase in heart rate with assumption of upright posture. " -Read more in the full article, below. 

Garland, E. M., Celedonio, J. E., & Raj, S. R. - Autonomic Dysfunction, 2015

Postural tachycardia syndrome: a UK occupational therapy perspective

Jenny Welford, Christopher McKenna - The British Journal of Cardiology, November 2015

"Postural tachycardia syndrome (PoTS) is a form of dysautonomia, a term used to describe dysfunction of the autonomic nervous system. Those living with PoTS can experience a vast array of symptoms that can be life-altering and debilitating. As well as a significant increase in heart rate upon standing, as a result of orthostatic intolerance, syncope and presyncope can occur, along with headaches, fatigue, palpitations, nausea and dizziness, which are usually relieved by lying down. Other autonomic functions, such as digestion, bladder control, temperature regulation and stress responses, may also be affected. Onset can be sudden or gradual, and for some individuals, there will be no known cause."

Pathogenesis and Individualized Treatment for Postural Tachycardia Syndrome in Children

Wen‐Rui Xu, Hong‐Fang Jin, Jun‐Bao Du - Chinese Medical Journal, October 2017

Objective: Postural tachycardia syndrome (POTS) is one of the major causes of orthostatic intolerance in children. We systematically reviewed the pathogenesis and the progress of individualized treatment for POTS in children.

Results: Studies have shown that POTS might be related to several factors including hypovolemia, high catecholamine status, abnormal local vascular tension, and decreased skeletal muscle pump activity. In addition to exercise training, the rst‐line treatments mainly include oral rehydration salts, beta‐adrenoreceptor blockers, and alpha‐adrenoreceptor agonists. However, reports about the effectiveness of various treatments are diverse. By analyzing the patient’s physiological indexes and biomarkers before the treatment, the ef cacy of medication could be well predicted.

Conclusions: The pathogenesis of POTS is multifactorial, including hypovolemia, abnormal catecholamine state, and vascular dysfunction. Biomarker‐directed individualized treatment is an important strategy for the management of POTS children. 

Effects of intermittent intravenous saline infusions in patients with medication—refractory postural tachycardia syndrome

Mohammed Ruzieh, Aaron Baugh, et al - Journal of Interventional Cardiac Electrophysiology · February 2017

" Intermittent IV infusions of saline dramatically reduce symptoms and improve quality of life in patients suffering from POTS. Further work should explore its efficacy as a bridge study for patients of high symptomatic severity."

Joint Hypermobility Syndrome and Postural Orthostatic Tachycardia Syndrome (HyPOTS)

Dana Mandel, Ali D. Askari, et. al. - Biomedical Research and Clinical Practice, 2017

Objective: To evaluate the association between joint hypermobility syndrome associated with postural orthostatic tachycardia syndrome (HyPOTS) and fibromyalgia.

Results: HyPOTS is a chronically disabling musculoskeletal disorder presenting clinically as widespread musculoskeletal pain and/or fatigue with joint hyper mobility. However, HyPOTS may be inadvertently diagnosed as chronic fatigue syndrome or fibromyalgia. In fact, the group of fibromyalgia patients evaluated at a rheumatology outpatient clinic were found to meet the clinical criteria for HyPOTS.

Conclusions: Patients diagnosed with fibromyalgia and chronic fatigue syndrome may benefit from a further evaluation for HyPOTS. Thus, if HyPOTS is properly defined, a wide range of therapeutic options for these patients become available in order to improve their physical manifestations and quality of life.

Common Medications for POTS:

Drugs which slow down heart rate: 

Beta Blockers, Ivabradine

Alpha Agonist: 


Selective Serotonin Reuptake Inhibitor (SSRI) 

sertraline, escitalopram, citalopram, paroxetine

(SSRIs are usually prescribed to treat depression and anxiety disorders, but recently, some evidence has emerged showing that serotonin plays a part in the control of both heart rate and blood pressure and may therefore be useful in treating POTS)

Serotonin-Noradrenaline Reuptake Inhibitor (SNRI): 

bupropion, venlafaxine, duloxetine

(SNRIs may worsen tachycardia in patients with PoTS)

Medications that Increase Blood Volume: 

(This is a synthetic steroid that retains salt and produces an increase in the volume of blood within the blood vessels. . It does not have all the same side effects as other steroids (e.g. prednisolone) that often worry patients. Blood potassium levels need to be monitored.)

This is a hormone that reduces urine production, promotes fluid retention and therefore decreases heart rate, improving symptoms of PoTS

This hormone increases the production of red blood cells and subsequently increases blood volume.  Erythropoietin causes blood vessels to narrow.

Other Medications

Clonidine, Methyldopa
These lower the heart rate and may reduce blood pressure by working directly on the brain. 

Narrows blood vessels in the abdominal cavity.  Daily injections can be a drawback, but a long-acting form that can last weeks has been developed.


Acts at the nervous system "autonomic ganglia" to increase vagal tone, which can reduce heart rate.  Side effects may include stomach pain, nausea diarrhoea which can be troublesome for some patients.  


This is a stimulant normally used in some sleep disorders, and may improve alertness and decrease mental clouding in those with PoTS. Modafinil may increase tachycardia in some patients but this effect is not very severe . 

Courtesy of POTS UK 

Information gathered from www.potsuk.org and written by Lorna Nicholson, medically approved by Dr. Satish Raj, Dr. Lesley Kavi - patients should understand that the information above are general recommendations and individuals must seek physician approval and advice prior to beginning any medical protocol.

Quality of Life in Patients with POTS (2002)

Conclusions: Patients with POTS experience clear limitations across multiple domains of quality of life, including physical, social, and role functioning. Treatment should address the multiple and varied impairments experienced by these patients and may require a multidisciplinary approach. Future research must further delineate factors, both disease related and psychosocial, that predict functioning and adjustment in this population.

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