Signs You Might Have POTS (and What to Do Next)

Do you feel dizzy, shaky or exhausted every time you stand up? Does your heart race for no clear reason? These can be signs of postural orthostatic tachycardia syndrome (POTS), a condition that's often missed or misdiagnosed. Here's what to look for & what to do next.

What Is POTS?

POTS is a form of dysautonomia, a disorder of the autonomic nervous system. That's the system that runs automatic functions like heart rate & blood pressure.

When you stand up, your body normally adjusts to keep blood flowing to your brain. With POTS, that adjustment doesn't work well, and your heart rate jumps to compensate: by 30 beats per minute or more in adults (40 or more for patients under 19), within 10 minutes of standing, without a drop in blood pressure.

Common Signs of POTS

POTS looks different in every person, but common symptoms include:

• Dizziness or lightheadedness, especially when standing

• A racing or pounding heart

• Fatigue & exhaustion

• Brain fog or trouble concentrating

• Fainting or nearly fainting

• Shakiness or excessive sweating

• Shortness of breath

• Headaches

• Nausea or bloating

• Hands & feet that turn purple or pale when standing

• Trouble sleeping

What Can Make Symptoms Worse?

Many people with POTS notice their symptoms flare with:

• Heat, including hot showers, baths & warm weather

• Standing for a long time, like waiting in line or shopping

• Strenuous exercise

• Illness

• Menstruation

For Phoenix patients: our long, hot summers can be especially hard with POTS. If heat is a trigger for you, talk with your physician about a plan for staying cool & managing symptoms during the warmest months.

Who Gets POTS?

POTS affects more than 500,000 people in the United States. It's most common in women between ages 15 & 50, but anyone can develop it.

POTS often appears after a stressor like a viral illness, pregnancy, surgery or a head injury. It's also more common in people with certain conditions, including Ehlers-Danlos syndrome & some autoimmune conditions. Learn more in our post on how EDS, POTS & MCAS are connected.

How POTS Is Diagnosed

POTS is diagnosed by measuring how your heart rate & blood pressure respond when you change position. The most common test is a tilt table test, where you lie on a table that tilts you upright while your vitals are monitored. Your doctor may also order blood work or other autonomic tests to rule out other causes.

Because POTS symptoms overlap with many other conditions, it can take time to get the right diagnosis. A careful history & the right testing make a big difference.

What to Do Next

If these signs sound familiar:

1. Track your symptoms. Note when they happen, what you were doing & how long they last. If you can, record your heart rate lying down & after standing for a few minutes.

2. Talk to your doctor. Bring your symptom log & ask whether POTS testing makes sense for you.

3. Don't make big changes on your own. POTS is often managed with fluids, salt, compression garments, gentle reclined exercise & sometimes medication, but the right plan depends on your health. Check with your doctor before increasing salt or starting new exercise.

4. Get coordinated care. POTS often involves cardiology, neurology & primary care. Having one physician connect the dots saves time & frustration.

When to get help right away: if you faint & are injured, or have chest pain or trouble breathing, call 911 or go to the nearest emergency department.

How PICM Can Help

At Phoenix Integrative Concierge Medicine, our physicians bring added focus to POTS & autonomic dysfunction. Extended visits give us time to hear your full story, support your evaluation & coordinate with cardiology & neurology. Once you're diagnosed, we help manage the day-to-day & adjust your plan over time.

Frequently Asked Questions

Is POTS curable?

There's no cure, but symptoms often improve with the right management plan. Cleveland Clinic reports that symptoms improve in about 8 out of 10 cases.

Is POTS the same as anxiety?

No. POTS is a physical condition of the autonomic nervous system. Some symptoms, like a racing heart & shakiness, can feel similar to anxiety, which is one reason POTS is sometimes misdiagnosed.

Think You Might Have POTS?

You don't have to figure it out alone. Schedule an intro call & we'll talk through your symptoms & next steps.

Sources

• Cleveland Clinic: Postural Orthostatic Tachycardia Syndrome (POTS)

• Cleveland Clinic Journal of Medicine: Evaluating & managing postural tachycardia syndrome

This article is for general information & isn't medical advice. Talk with your doctor before changing your diet, fluids, exercise or medications.