Postural orthostatic tachycardia syndrome (POTS)

Postural orthostatic tachycardia syndrome, also abbreviated as POTS, is a condition that causes the heart rate to increase significantly when someone gets up from a sitting or lying position. This may result in you feeling light-headed, blurred vision, sweating and fainting. It can have a major impact on your life because it is also associated with sleep problems, chronic fatigue and migraine-like headaches. Fortunately, the condition can often be easily controlled with lifestyle adjustments and there is also medication that can combat the symptoms.


  • Postural orthostatic tachycardia syndrome (POTS) in brief
  • Symptoms
  • Relationship with other conditions
  • Causes
  • Therapy

Postural orthostatic tachycardia syndrome (POTS) in brief

Postural orthostatic tachycardia syndrome , also known as postural tachycardia syndrome and abbreviated as POTS , is a condition in which the transition from a supine position (e.g. in bed) to an upright sitting or standing position can cause an abnormal increase in the heart rate that this causes. becomes very high. This high frequency in the heartbeat is called tachycardia when the heart makes more than 100 beats per minute. Meanwhile, insufficient oxygen-rich blood flows to the heart. This is bad for the heart and can be a threat to health if the heart rate is not quickly reduced.


The main symptom used to diagnose POTS is an increase in heart rate of at least 30 beats per minute within ten minutes after a person rises from a lying position to a sitting or standing position. In young people between 12 and 19, the increase must be 40 beats per minute to diagnose the condition.

The following complaints often occur as a result of the condition:

  • Pass out
  • Fatigue
  • Sleep problems
  • Headache
  • Blurred vision
  • Perspiration
  • Fears
  • Difficulty breathing or swallowing
  • Feeling light-headed
  • Shortness of breath
  • Nausea
  • General weakness
  • Difficulty with physical exertion
  • Hypersensitivity to heat

Most patients experience only a number of the above complaints. About a third of patients regularly faint when rising from a lying position. Almost half suffer from sleep problems such as sleep interruptions.

The increase in heart rate does not include a decrease in blood pressure in the case of POTS. This would indicate orthostatic hypotension , which is a significantly different condition. Medications that are sometimes prescribed to combat POTS can result in orthostatic hypotension.

Relationship with other conditions

POTS occurs above average in combination with the connective tissue disorder Ehlers-Danlos syndrome. With this condition, patients suffer from hypermobility of the joints and, in some types, very stretchy skin. In addition, a quarter of patients with POTS also suffer from vasovagal syncope, a form of fainting that causes general blood vessel dilation. In addition, a quarter to a half of POTS patients also suffer from chronic fatigue syndrome (CFS) and related exercise intolerance.


The cause of postural orthostatic tachycardia syndrome is sought in various abnormalities. For example, POTS occurs relatively often in people with low circulating blood volume, also called hypovolemia or volume depletion. This results in less blood flow to the heart. Many patients also have high levels of the hormone norepinephrine . This is known to lead to tachycardia.

Heredity plays a role in the condition . It runs in the family in at least one in eight patients. In some cases it can also be the result of a viral infection or a period of illness during which a person has been on bed rest for a long time. The orthostatic intolerance may then be caused by getting used to a lying position from which the body no longer recovers.


An important piece of advice for patients with postural orthostatic tachycardia syndrome is to drink plenty of water , especially shortly after waking up. This is to increase blood volume and prevent the risk of symptoms occurring. In addition, it is often recommended to take extra salts and electrolytes for the same purpose, but only if there are no problems with blood pressure. It is known that eating large meals can increase the chance of symptoms occurring. It is therefore recommended to consume several smaller meals spread throughout the day. The intake of alcohol and caffeine should be avoided as much as possible because they stimulate urine production and can therefore cause hypovolemia to occur. A good physical condition can have a beneficial effect on the condition and therefore the practice of endurance sports is particularly recommended, provided that the physical condition allows this.

If lifestyle adjustments have insufficient effect, treatment with medication can be considered. Until 2019, there are no medications specifically intended for the treatment of POTS. However, medication can be used that limits salt excretion, such as fludrocortisone , or medication that constricts the blood vessels, such as midodrine (a vasoconstrictor). These medications can only be used by patients with low or normal blood pressure. Patients with high blood pressure may benefit from a beta blocker such as propranolone to lower heart rate without further increasing blood pressure.