Home General Medicine What is POTS? What Are Its Causes?

What is POTS? What Are Its Causes?

POTS, acronym for postural orthostatic tachycardia syndrome, is a condition where blood stays in the lower half of your body even when you stand up, causing your heart rate to increase significantly. POTS can affect anyone but is more commonly observed in girls and women between the ages of 15 to 50 years.

What is POTS?

Usually, your heart rate should be the same when you sit up, lie down, or stand. However, people with Postural Orthostatic Tachycardia Syndrome have a heart rate that changes whenever they change positions. This is known as Orthostatic Intolerance (OI) and is one of the most common symptoms of POTS. It can cause dizziness, fainting, or lightheadedness.

POTS is classified based on its cause. Some of the common forms include:

  • Neuropathic: When there is damage to the small fiber nerves responsible for the blood flow to and from the limbs and abdomen
  • Hyperadrenergic: When the level of the stress hormone is too high
  • Hypovolemic: When the blood level is unusually low

What are the Symptoms of POTS?

POTS symptoms are more pronounced after a meal when the blood is redirected to your digestive tract. You might also experience the symptoms when stressed, standing in line, or in the shower.

  • Pain in the stomach
  • Dizziness or fainting
  • Blurry vision
  • Brain fog
  • Feeling hot or cold
  • Shaking or tremors
  • Excessive sweating
  • Nausea
  • Vomiting
  • Bloating
  • Diarrhea or constipation
  • Extreme fatigue
  • Higher or lower blood pressure
  • Changed heart rate
  • Chest pain
  • Anxiety
  • Headaches, body aches, or neck pain
  • Insomnia
  • Unusual color of the hands and feet

What causes POTS?

Unfortunately, scientists and researchers do not have a clear understanding of what causes Postural Orthostatic Tachycardia Syndrome (POTS). However, it has been observed that most people with this condition begin to notice their symptoms after major surgery, pregnancy, trauma, or viral illness. The symptoms might also increase before a menstrual period.

Most researchers believe that multiple factors may cause POTS. There are several associated abnormalities with the condition which can influence its development and progression. These include:

  • Damaged nerves in certain muscles, especially in the legs and feet
  • Abnormal decrease in the levels of blood
  • Less blood returning to the heart when shifting positions
  • Heart disease
  • Fluctuating blood pressure
  • Increased stress levels

A small percentage of people with POTS have a family history of OI. This implies that there might be a genetic factor involved in the cause of POTS.

What are the Risk Factors for POTS?

Most people with POTS are girls and women between 15 and 50 years old. Many in this category report symptoms of POTS just before their menstrual period. However, certain factors increase the chances of developing the condition. These include:

  • A viral illness, severe infection, medical illness, pregnancy, or trauma that requires hospitalization and bed rest
  • A recent history of mononucleosis
  • Autoimmune conditions like Sjogren’s syndrome and celiac disease

How is POTS Diagnosed?

The primary indicator of POTS is an increased heart rate after standing up. The increase has to be more than 30bpm and must be observable within ten minutes of changing positions. The increased heart rate must also last for at least 30 seconds. This increase in heart rate should also be accompanied by other symptoms of POTS.

In order to determine if you meet these criteria for an official diagnosis, your doctor might recommend a few tests. These tests include:

  • Tilt Table Test: You will be asked to lie on a tilt table while your blood pressure and heart rate are monitored. The bed will be slowly tilted to an upright position.
  • Active Stand Test: You will be asked to lay down, and your heart rate and blood pressure will be checked. You will then be asked to stand up, and the measurements are immediately recorded. The measurements are again taken after 2, 5, and 10 minutes.
  • Electrocardiogram (ECG): This test checks the electrical activity of your heart.
  • Echocardiogram: This gives your doctor an ultrasound of your heart.
  • 24-hour Blood Pressure and Heart Rate Monitoring: Several small devices will be attached to your belt to take regular readings for 24-hours while carrying out regular activities.
  • Blood Tests: Kidney, liver, thyroid function, blood count, calcium, and glucose levels are checked to rule out any other underlying causes for the symptoms

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How is POTS Treated?

Unfortunately, there is no specific cure for POTS. If the condition’s underlying cause is determined, then your doctor will put you on a treatment plan to address it. In most cases, doctors recommend that POTS symptoms be managed as follows:

Compression stockings: These stockings help push blood up from your legs to the heart. You should have ones that provides at least 30 – 40 minutes of compression and go all the way up to the waist, or at least up to the thighs. Your physician can prescribe a pair.

Medication: Your treating doctor may prescribe medications like phenylephrine, midodrine, fludrocortisone (including more salt and water), or a type of drug called beta-blocker to help with the blood flow.

Exercise: While POTS can make it hard to be active, even light exercises like simple yoga or walking can help with the blood flow and keep the heart healthy.

Diet: Salt and water play a significant role. They help keep liquids in the body and raise the amount of blood in your body. Eat olives, pickles, salted broths, and nuts. Take smaller meals more often with a healthy balance of fruits, vegetables, protein and dairy.

Lifestyle:  If you get easily tired, you may not have the energy always to take care of yourself. Learn how to check your pulse and blood pressure. Talk to your doctor to know what your numbers should ideally be, and check them regularly.

Sleep: Try set up a routine sleep schedule. You can also raise the height of your bed’s head to enable you to stand up easily after lying down.

Communication:  AsPOTS makes simple activities a bit harder, which can make you frustrated and stressful, a therapist or support group can help you manage emotional issues the condition can cause.


While POTS is not necessarily a life-threatening condition, it could be indicative of a much more serious underlying condition. If you are experiencing the symptoms of POTS, then please consult with a healthcare expert today.

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