London Heart

Postural Orthostatic Tachycardia Syndrome (POTS)

What is POTS?

POTS – known fully as Postural Orthostatic Tachycardia Syndrome – is a rare condition characterised by a significant increase in heart rate within 10 minutes of going from lying down to sitting up, or sitting to standing, resulting in symptoms such as fatigue, dizziness, palpitations and shortness of breath.

This reaction is known as ‘orthostatic intolerance’, meaning symptoms are triggered by the shift into an upright position, and relieved by lying down. To be diagnosed with POTS, there is usually either an increase in heart rate greater than 30 beats per minute, or to a heart rate greater than 120 beats per minute.

POTS symptoms can range from mild to severe and for some people, the condition can be very debilitating and have a major impact on day-to-day life. The good news is though, the condition can be well managed and most people find their symptoms do get better.

Are you experiencing symptoms that may be POTS? Leading London cardiologist Dr Syed Ahsan treats patients with a wide range of heart-related symptoms and conditions: Get in touch via our online booking form to book a consultation or give us a call on 0203 303 0325.

What are the symptoms of POTS and is POTS serious?

One of the main symptoms of POTS is fatigue, or ongoing extreme tiredness. This is often what causes people to first talk to their doctor, as the exhaustion can significantly interfere with daily life.

Shortness of breath and palpitations are another key symptom, along with feeling dizzy, lightheaded and possibly nauseas too. For some, POTS can also lead to blackouts or syncope/fainting, although this is rare. Our information video on POTS symptoms explains more.

Although changing into an upright position is what triggers POTS, the symptoms can sometimes feel almost constant and unrelenting – particularly in more severe cases – and even very minimal exertion can cause extreme tiredness and shortness of breath. This can make daily life very difficult, as even things like getting dressed, having a shower, and carrying out simple tasks at work may become challenging. Many people with POTS experience symptoms of low mood, depression and anxiety too.

However, it’s important to remember that while POTS can feel very alarming, it isn’t dangerous or life-threatening and isn’t associated with any long-term heart damage. You can read more about this in our blog: Is POTS Life threatening? Our information video on this topic explains more too.

Who gets POTS?

Anybody can potentially develop the condition, but POTS is most common in females and younger age groups, with women aged 15-25 years most affected. Generally, people with POTS find their symptoms improve as they get older, although this isn’t always the case and some may find they’re affected throughout their life. Our information video on the typical POTS patient explains more.

What causes POTS?

POTS is still a bit of a mystery, but there are a few things we understand about it. It’s one of a number of conditions that leads to an increase in heart rate on standing/shifting to an upright position, which means something is not quite right with the autonomic nervous system (this controls functions within the body that happen without us needing to be consciously aware of them, such as digestion, sweating and heartbeats).

It is, in fact, normal for the heart rate to increase slightly when we stand up, in order to maintain the necessary blood supply to the heart and brain. But in people with POTS, this response is disrupted. Because the autonomic nervous system doesn’t respond normally, there is a sudden drop in blood supply to the heart and brain – which then causes the heart rate to rise excessively as it attempts to compensate for this. This coincides with increased levels of the stress hormone norepinephrine in the blood.

It’s not certain what causes this to happen in some people and not others, although there are a number of theories. One is that, for various reasons, the body is not as good as it should be at pumping blood back to the heart, which could be due to low blood volume, or that the nerves which co-ordinate this process aren’t functioning properly. Our information video on POTS causes explains more.

How is POTS diagnosed?

Many people with POTS aren’t diagnosed right away, and it’s very common for people to live with symptoms for a number of years until they find out what’s wrong.

This is due to a number of factors, including lack of awareness of the condition. The symptoms can also be vague and overlap with a lot of other conditions, including very common things like anxiety. Diagnosing POTS often starts with ruling out other possible causes, which will usually involve blood tests and possibly an ECG or ultrasound scan of the heart.

Once other conditions are ruled out, the next stage is a ‘tilt table test’. This involves lying on a table while attached to a heart rate and blood pressure monitor. The table is then tilted into an almost standing position, enabling the doctor to monitor the changes in blood pressure and heart rate in response.

How is POTS treated?

As with many conditions, there is no cure for POTS, but there’s a lot we can do to help manage it and keep symptoms under control, and the prognosis for people diagnosed with POTS is generally very positive.

For most people, lifestyle measures are a key step, although there are medications that can also help with certain symptoms if required.

It may take a bit of time to discover what works best for you – your specialist will be able to advise and guide you on how to approach this. It’s important to allow yourself time to rest and take it easy when you need to, so letting those close to you know about your condition can help.

These are some of the key treatments for POTS:

Exercise: Following a structured exercise programme for three months has been found to help with POTS symptoms. Regular physical activity can also help with regulating energy levels and boosting psychological wellbeing. Your specialist will be able to advise on how to approach exercise.

Compression garments: Some people find wearing compression garments on their legs helps. The compression helps squeeze the blood back through the veins and into the heart more efficiently, and reduces some of the pressure off the heart.

Diet and hydration: Keeping well hydrated can be very important for people with POTS, as this increases blood volume and makes it easier for the body to return blood to the heart. It’s also a good idea to consider your diet: Eating small, regular meals can be beneficial, and generally following a healthy, balanced diet.

Medication: When lifestyle measures alone aren’t enough, or symptoms are severe, there are a number of drugs that can be prescribed too. These mostly work by either helping regulate heart rate, or increasing the amount of fluid in the body, which means the heart is able to work more efficiently.

Managing stress: While it can feel challenging at first, making lifestyle shifts in order to ensure you keep your stress levels in check can be an important part of managing any health condition, including POTS. Being mindful, making time for relaxation and rest and getting plenty of sleep all helps.