POTS - Postural Orthostatic Tachycardia Syndrome: A guide for patients

Postural Orthostatic Tachycardia Syndrome – POTS: A guide for patients

If you’ve ever felt dizzy, lightheaded, or noticed your heart racing after simply standing up, you’re not alone. These symptoms may point to a condition called Postural Orthostatic Tachycardia Syndrome, or POTS – a form of autonomic dysfunction that affects blood flow and heart rate regulation. It’s often misunderstood or misdiagnosed, which can make the journey to a proper diagnosis frustrating for many patients.

In this blog, I’ll walk you through what POTS is, how we investigate it, and how it can be managed with a combination of lifestyle strategies, physiologic manoeuvres, and (when needed) medication.

What is POTS?

POTS is a condition where the autonomic nervous system doesn’t regulate blood flow properly when you change position – especially from lying down to standing. This causes your heart to beat significantly faster in an attempt to maintain blood pressure and blood flow to the brain.

The diagnostic hallmark is a rise in heart rate of 30 beats per minute or more (or over 120 bpm in total) within 10 minutes of standing, without a significant drop in blood pressure.

Dr Amin private consultant cardiologist assesses symptoms suggestive of POTS and provide proper management plan

What are POTS symptoms?

Symptoms can vary from day to day and from person to person, but typically include:

Fast heart rate (palpitations) when standing
Dizziness, lightheadedness, or near-fainting
Fatigue and weakness
“Brain fog” or difficulty concentrating
Nausea or gastrointestinal upset
Shortness of breath
Shakiness, anxiety, or tremor
Sweating or cold extremities

These symptoms tend to improve on lying down and worsen with prolonged standing, heat, or dehydration.

How to diagnose POTS?

If symptoms are suggestive of POTS, we start by taking a detailed clinical history and physical examination. From there, we can plan investigations to confirm the diagnosis and rule out other causes of your symptoms.

Dr Amin private cardiology consultant can arrange for Tilt table test to diagnose POTS

12-lead ECG: To check for any electrical abnormalities in the heart.

Active Stand Test: We record your heart rate and blood pressure at rest and at intervals after standing for up to 10 minutes.

Tilt Table Test: A more controlled version of the stand test that uses a motorised table to simulate posture changes.

24-hour Holter Monitor: To assess heart rate variability and rule out arrhythmias. Other devices can also be used.

Echocardiogram: To look at heart structure and function.

Blood Tests: To check for anaemia, thyroid problems, adrenal issues, and vitamin deficiencies.

Autonomic Testing: Sometimes needed in more complex cases to assess how well your nervous system responds to stimuli.

Dr Amin private cardiology consultant will choose the appropriate monitor for POTS diagnosis

Management of POTS

POTS management is highly individualised, and the goal is to reduce symptoms, improve quality of life, and prevent fainting or functional decline. Many patients improve significantly with non-drug strategies alone.

Lifestyle & Physiological Manoeuvres:

These are the first line of treatment and often the most effective.

Hydration: Aim for 2.5 to 3 litres of fluid daily.
Salt: Increasing salt intake (up to 8–10g per day) helps expand blood volume. This should be done under supervision.
Compression garments: Waist-high compression stockings or abdominal binders reduce blood pooling in the legs.
Physical reconditioning: Start with recumbent or semi-recumbent exercise (such as rowing, swimming, or recumbent biking) and gradually progress.
Avoid triggers: Such as hot environments, alcohol, and prolonged standing.

Physiologic Manoeuvres (especially helpful during symptom onset):

Leg crossing and muscle tensing: Engaging the leg muscles can help return blood to the heart.
Squatting or sitting down when lightheaded.
Tilting the bed head up by 10–15 cm can help your body adjust to upright posture overnight.

Medications

If lifestyle changes are not enough, medications can be introduced cautiously:

Beta-blockers (e.g., propranolol, bisoprolol) – To reduce heart rate.
Ivabradine – A more selective heart rate reducer that doesn’t affect blood pressure as much.
Fludrocortisone – Helps retain salt and water to increase blood volume.
Midodrine – Constricts blood vessels to improve blood pressure when standing.
Pyridostigmine – Improves autonomic nerve transmission.

Medication choices depend on your specific symptoms, blood pressure profile, and any other conditions you may have. It often takes time and close follow-up to find the right combination.

Where Can I Learn More?

Reliable information is key to managing POTS well. I recommend the following trusted resources:

STARS (Syncope Trust and Reflex Anoxic Seizures): www.stars.org.uk
Dysautonomia International: www.dysautonomiainternational.org
PoTS UK: www.potsuk.org – Excellent UK-based support and educational resource
British Heart Foundation: www.bhf.org.uk

Final Thoughts

POTS can be a challenging condition to live with, but with the right diagnosis and management plan provided by Dr Amin, consultant cardiologist, symptoms often improve significantly. Some patients make a full recovery, while others learn how to manage their symptoms and live full, active lives.

If you or someone you know is experiencing symptoms that sound like POTS, Dr Amin would be happy to assess and guide you through a tailored plan – whether it involves further investigation, physiologic treatment, or medical therapy.