POTS
Racing heart when you stand up
What is POTS?
POTS stands for Postural Orthostatic Tachycardia Syndrome. When you stand up, your heart beats much faster than it should. This can cause dizziness, lightheadedness, or feeling like you might faint. You may also feel your heart pounding, get tired quickly, or have brain fog.
Normally, when you stand, your nervous system adjusts your blood flow automatically. With POTS, that adjustment doesn't work well, so your heart speeds up to compensate.
POTS is real, it is recognized, and it is treatable. Many people with POTS feel much better with the right plan.
Common symptoms
- •Dizziness or lightheadedness, especially when standing
- •Racing or pounding heart, on standing or with activity
- •Extreme fatigue
- •Brain fog
- •Nausea
- •Headaches
- •Blurry vision
- •Feeling faint
How is POTS diagnosed?
We check heart rate and blood pressure lying down, then again after standing. If heart rate rises by 30 beats per minute or more within 10 minutes of standing, and symptoms are present, that meets criteria for POTS.
Blood tests may be ordered to rule out other causes:
- •Thyroid problems
- •Anemia
- •Low blood sugar
- •Vitamin or mineral deficiencies
- •Dehydration
Do I need a tilt table test?
Not always. A tilt table test is not required to diagnose POTS.
In a tilt table test, you lie on a table that slowly tilts you upright while heart rate and blood pressure are monitored. It can help when the diagnosis is unclear, but it's an extra step, not a required one.
Your doctor may recommend it if standing vital signs are borderline, if you're fainting and more detail is needed, or to understand your specific type of POTS. Most patients can be diagnosed and treated without it.
How is POTS treated?
Most people start with lifestyle changes:
- •Drink more fluids: 2-3 liters, about 8-10 large glasses per day
- •Add more salt to your diet: 6-10 grams per day unless your doctor says otherwise
- •Wear compression stockings: waist-high, 30-40 mmHg
- •Exercise regularly, starting lying down or seated (rowing, swimming, recumbent bike) and build up gradually
- •Avoid triggers: heat, long periods of standing, large meals, alcohol, caffeine
- •Stand up slowly
- •If lifestyle changes aren't enough, your doctor may prescribe medication to lower heart rate, help your body hold onto fluid, or improve blood flow
What do your test results mean?
Normal blood tests are a good sign, they mean POTS is likely the cause of your symptoms, not something more serious.
Abnormal results help find an underlying cause that can be treated directly, like a thyroid problem or anemia.
A normal ECG rules out heart rhythm problems as the cause.
You are not alone. POTS is more common than many people realize, and research continues to improve how we treat it. Our team at The Heart House is here to work with you every step of the way.
Questions to ask your doctor
- 1.Do my standing vital signs meet the criteria for POTS?
- 2.Do I need a tilt table test, or can we diagnose and treat without one?
- 3.Which blood tests should I have to rule out other causes?
- 4.How much fluid and salt should I be taking in each day?
- 5.What kind of exercise should I start with, and how fast should I build up?