POTS (Postural Orthostatic Tachycardia Syndrome)
Abnormal heart rate increase upon standing, causing dizziness, fatigue, and fainting.
Overview
POTS is a form of dysautonomia where the autonomic nervous system doesn't properly regulate heart rate and blood pressure when changing positions. Upon standing, heart rate increases excessively (30+ bpm or over 120 bpm) without a significant blood pressure drop. This causes blood to pool in the legs, reducing blood flow to the brain and causing symptoms like dizziness, fatigue, and brain fog. POTS commonly follows viral infections and has increased significantly after COVID-19.
Common Age
Usually 15-50, predominantly women
Prevalence
1-3 million Americans; increased after COVID-19
Duration
Chronic but often improves over years; some fully recover
Common Symptoms
- Rapid heartbeat upon standing
- Dizziness and lightheadedness
- Fainting or near-fainting
- Extreme fatigue
- Brain fog and difficulty concentrating
- Exercise intolerance
- Nausea
- Headaches
- Shortness of breath
- Tremulousness
- Chest pain
- Temperature regulation problems
- Sleep disturbances
- Symptoms worse in heat, after meals, with dehydration
Possible Causes
- Viral infections (including COVID-19)
- Autoimmune conditions
- Genetic connective tissue disorders (EDS)
- Physical deconditioning
- Post-concussion
- Post-surgery
- Neuropathy
- Mast cell activation syndrome
- Unknown (idiopathic)
Note: These are potential causes. A healthcare provider can help determine the specific cause in your case.
Quick Self-Care Tips
- 1Increase salt and fluid intake
- 2Wear compression garments
- 3Rise slowly from lying/sitting
- 4Avoid prolonged standing
- 5Recondition with recumbent exercise
- 6Avoid heat and large meals
- 7Elevate head of bed
- 8Small frequent meals
Disclaimer: These are general wellness suggestions, not medical treatment recommendations. They may help manage symptoms but should not replace professional medical care.
Detailed Treatment & Solutions
1INCREASE FLUIDS AND SALT
Aim for 2-3 liters of fluid daily. 3-10 grams of salt (unless contraindicated). Electrolyte drinks. Salt tablets if needed. This increases blood volume.
2COMPRESSION
Waist-high compression stockings (30-40 mmHg) prevent blood pooling. Abdominal binders also help. Wear during the day, especially when upright.
3EXERCISE RECONDITIONING
Start with recumbent exercise (recumbent bike, swimming, rowing). Gradually increase intensity. Avoid upright exercise initially. Specific POTS exercise protocols exist.
4MEDICATIONS
Fludrocortisone (increases blood volume). Midodrine (constricts blood vessels). Beta-blockers (slows heart rate). Ivabradine. Others depending on subtype.
5LIFESTYLE MODIFICATIONS
Avoid triggers: heat, alcohol, large meals, prolonged standing. Rise slowly. Flex leg muscles when standing. Counter-maneuvers (crossing legs, squatting).
6ADDRESS UNDERLYING CONDITIONS
Treat autoimmune issues, mast cell activation, or other contributors. Physical therapy. Occupational therapy for daily functioning.
Important: Always consult a healthcare professional before starting any treatment regimen. The solutions above are for educational purposes and may not be suitable for everyone.
Risk Factors
- Female gender
- Recent viral infection
- Connective tissue disorders
- Autoimmune conditions
- Deconditioning
Prevention
- Maintain fitness
- Adequate hydration
- Avoid deconditioning during illness
When to See a Doctor
Consult a healthcare provider if you experience any of the following:
- Symptoms of rapid heart rate and dizziness upon standing
- Fainting or near-fainting episodes
- Symptoms after viral infection
- Unable to tolerate upright posture
- Significantly affecting daily functioning
Talk to a Healthcare Provider
If your symptoms are persistent, severe, or concerning, please consult with a qualified healthcare professional for proper evaluation and personalized advice.
Frequently Asked Questions
QIs POTS serious?
POTS is not life-threatening but can be severely disabling, affecting ability to work, attend school, or perform daily activities. Quality of life impact is significant. With proper treatment, most people improve substantially, though full recovery varies. It's a real medical condition despite sometimes being dismissed.
QDid COVID cause my POTS?
COVID-19 has triggered a significant increase in POTS cases. Post-COVID POTS is a recognized form of Long COVID. The virus may cause autoimmune reactions, neuropathy, or deconditioning that triggers POTS. Treatment is similar to other causes. Many post-COVID POTS patients improve over time.
Related Conditions
Chronic Fatigue
Persistent tiredness that doesn't improve with rest and affects daily activities.
Fibromyalgia
A disorder causing widespread musculoskeletal pain, fatigue, and tender points.
Fibromyalgia
A chronic condition causing widespread pain, fatigue, sleep problems, and cognitive difficulties.
Long COVID (Post-COVID Syndrome)
Persistent symptoms lasting weeks or months after initial COVID-19 infection.
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Medical Disclaimer
The information on this page is for educational purposes only and is not intended as medical advice. It should not be used for self-diagnosis or self-treatment. Always seek the guidance of a qualified healthcare professional with any questions you have regarding a medical condition. If you are experiencing a medical emergency, call your local emergency services immediately.
Information last reviewed: January 2026
This page provides educational information only. It is not medical advice.