London Heart

Postural Orthostatic Tachycardia Syndrome (POTS)

What is POTS?

POTS is a rare condition that can lead to people feeling very lethargic and short of breath with palpitations. When someone has POTS, their heart rate increases significantly within 10 minutes of going from sitting to standing or the heart rate increases to over 120 beats per minute in that time.

What are the symptoms of POTS?

Most people who have POTS initially seek medical attention because they feel extremely lethargic and feel like they have no energy. They get short of breath on very little exertion and sometimes on no exertion at all. They can sometimes feel light-headed and dizzy although it is rare for people with POTS to actually pass out. These symptoms tend to be unrelenting and often last for more than 6 months. They can affect people’s quality of life significantly and can affect how well people sleep. The symptoms can also predispose to low mood and depression.

Who gets POTS?

POTS generally affects younger people (generally between 15-25 years old). Generally, as people get older, the symptoms disappear but it affects some throughout their life. Patients with POTS also tend to be female, although no one is quite sure why that is.

What causes POTS?

No one is quite sure what the cause of POTS is. There are several theories but none have been completely proven. Generally, POTS is thought of as a group of conditions which all, by various ways, lead to an increase in heart rate on standing. One possible mechanism, is that, for various reasons, the body is not as good at pumping the blood back to the heart. The reasons for this maybe that there isn’t enough blood volume in the body or that the nerves which co-ordinate the blood being returned to the heart aren’t functioning quite as well as they should.

How is POTS diagnosed?

There are many different reasons for someone to feel lethargic and short of breath with a fast heart rate. Therefore, the first thing to do is to make sure there is no other reason for these symptoms. This is generally done by blood tests and an ultrasound scan (echo) of the heart to make sure there are no abnormalities with the function of the heart.

Once other conditions have been ruled out, the next stage is a Tilt table test. This is a test where you lie on a table which is flat. It is then tilted up so you are almost standing. Your heart rate and blood pressure can be measured when lying down and standing. Typical changes in your heart rate and blood pressure can help make a diagnosis.

How is POTS treated?

There are a number of ways to treat POTS. The main aim of treatments is to help the symptoms of POTS as there is (as yet) no way to cure the condition.

The various treatments are as follows:

  • Exercise – Many people find that following a structured exercise programme for 3 months can help with the symptoms and can help with stopping the heart beat as fast.
  • Compression garments – Some people find that wearing compression garments on their legs help with the symptoms. The compression helps squeeze the blood back through the veins and into the heart more efficiently and helps take some of the pressure off the heart.
  • Increased fluid intake – Some people find that drinking more fluid than normal helps the symptoms, as it increases the blood volume and makes it easier for the body to return the blood to the heart.
  • Drugs – There are a number of drugs that are used to either control how fast the heart is beating. Other drugs can increase the amount of fluid in the body which means the heart doesn’t have to work as hard as the blood is being returned to the heart more efficiently.

Not all of these treatments work for everyone, your Cardiologist will discuss them in more detail with you and, with you, come up with a plan for how to try and get the symptoms under control.