Postural orthostatic tachycardia syndrome (POTS) is a chronic autonomic disorder characterized by a rapid increase in heart rate upon standing with stable blood pressure. This ailment can sometimes be burdensome, making it difficult for people to engage in daily activities. It is more common in women, with symptoms usually first occurring during adolescence or adulthood.^[1]

People with POTS may also have other conditions such as Ehlers-Danlos syndrome (EDS), mast cell activation syndrome (MCAS), fibromyalgia, and chronic fatigue syndrome.

Signs and symptoms are at their worst when attempting to stand up, during which people will experience an increase in heart rate with no blood pressure change. During these episodes, people often feel lightheaded, dizzy, and nausea. Symptoms usually improve when returning to a recumbent or supine position.

People may also experience brain fog, gastrointestinal problems, and fatigue.^[1]

A healthcare provider must rule out potentially reversible causes of symptoms, like side effects from drugs, and other conditions, like hyperthyroidism or infection. A physical exam, medical history, or blood testing may all be included in their assessment.

A common procedure to diagnose POTS is a tilt table test, in which a person is strapped to a table that slowly moves them into an upright position. Blood pressure, heart rate, and heart rhythm are recorded, as well as any symptoms that occur during the procedure. In adults, an increase in heart rate of more than 30 bpm upon standing or during the tilt table test is used to define POTS; the increase may be larger in adolescents (more than 40 bpm).

There are no standard treatments for POTS. Rather, treatment is focused on decreasing heart rate, increasing blood volume, and/or stabilizing blood pressure. Some of the most commonly prescribed drugs include mineralocorticoids (e.g., fludrocortisone) vasopressin receptor agonists (e.g., desmopressin), beta-blockers (e.g., metoprolol and propranolol), and alpha-agonists (e.g., midodrine). One liter of normal saline given intravenously over an hour also seems to be helpful, but this therapy isn’t recommended for long-term use. ^[1]

There is little to no research on supplements for treating POTS. Some studies have found that people with POTS are at risk for vitamin B12 and vitamin B1 deficiencies^[2], but there haven’t been any studies to determine if supplementing with these vitamins is beneficial. While not studied for POTS specifically, deficiencies in iron and vitamin D are common among patients with chronic fatigue and autonomic dysfunction, and correcting these deficiencies could resolve symptoms.^[3]

In one randomized controlled trial, a high sodium diet (300 mEq or 6.9 grams daily) was found to lower standing heart rate and increase blood and plasma volume when compared to a low sodium diet (10 mEq or 0.2 grams daily).^[4] Thus, It is generally recommended that people with POTS consume roughly 2–3 liters of fluids and 3–10 grams of sodium daily (equivalent to about 1 to 3.5 tablespoons of table salt daily).^[1]

One study showed that following a gluten-free diet alleviated some symptoms of POTS; however, more rigorous research is needed to confirm this.

A carefully designed exercise program including both resistance training and endurance training has been shown to improve quality of life and reduce symptoms in people with POTS. Some physical maneuvers can help increase tolerance to standing, like squeezing a rubber ball, leg crossing and muscle tensing, and cooling the skin with a spray bottle or fan.^[1][5]

The cause of POTS is unknown. It is often seen after certain events that can cause physical stress, such as infection and concussion, or after pregnancy. However, it is not certain if these events cause POTS or are merely associated with it.

Genetics and family history play a role in POTS, but the specific genes responsible are as yet undefined. Furthermore, conditions that may affect muscle control or connective tissue function, (e.g., Ehlers-Danlos syndrome) or are associated with hormonal changes (e.g., puberty or menopause), may also cause POTS.^[3]