What Is POTS? Understanding Postural Orthostatic Tachycardia Syndrome

You might have seen the term trending on social media or discussed in recent health news, but many people still find themselves asking the experts at INTEGRIS Health a simple question: What is POTS? It is a complex condition affecting the autonomic nervous system, often leaving individuals feeling lightheaded, dizzy or faint simply by standing. While the symptoms can feel overwhelming and sometimes debilitating, understanding the mechanics of this syndrome is the vital first step toward reclaiming your quality of life.

We speak to Aleicia Mack, D.O., a cardiologist with the INTEGRIS Health Heart Hospital and INTEGRIS Health Cardiovascular Physicians Edmond, to learn more. 

“One of the most important things for patients to know is that POTS is real,” Dr. Mack says. “It is a form of autonomic dysfunction that can be associated with connective tissue diseases and/or autoimmune diseases that can cause the heart rate to rise abnormally when standing, often leading to dizziness, fatigue, brain fog, palpitations and exercise intolerance. With the right diagnosis and treatment plan, our patients at INTEGRIS Health see meaningful improvement in their POTS symptoms.” 

Understanding POTS

The basics: Postural Orthostatic Tachycardia Syndrome is a health problem that causes the heart rate to spike abnormally high when a person transitions from lying down to standing. In a healthy body, the autonomic nervous system automatically tightens blood vessels in the legs to push blood back up to the heart and brain against gravity. For people with this condition, that automatic signal doesn’t work correctly, causing blood to pool in the lower body and the heart to race to compensate.

• This condition disproportionately affects women between the ages of 15 and 50.
• Symptoms can appear abruptly after a viral illness, surgery or trauma.
• It is considered a chronic, invisible illness that varies in severity from day to day.

How POTS is diagnosed

What to expect: A POTS diagnosis often involves ruling out other cardiovascular issues and confirming specific heart rate criteria. While there are standard tests used to identify the condition, your doctor may not need to run every single type of test to reach a definitive diagnosis. The goal is to observe how your body reacts to gravity.

• Doctors often perform blood work to rule out anemia or thyroid issues.
• A detailed history of symptoms is just as important as the testing itself.
• You may be asked to stop certain medications before testing to get accurate results.

Increased heart rate upon standing is the primary clinical sign doctors look for during a physical exam. To meet the diagnostic criteria, the heart rate must increase by at least 30 beats per minute (or exceed 120 bpm) within the first ten minutes of standing.

• This increase must be sustained, not just a momentary spike.
• Blood pressure typically does not drop significantly (which would indicate orthostatic hypotension instead).
• The patient usually experiences their typical symptoms during this elevation.

The active stand test is a simple bedside assessment that can be performed in a regular clinic room. Doctors measure your heart rate and blood pressure while you are lying down, and then again at intervals after you stand.

• It is a quick, non-invasive way to screen for the condition.
• It mimics real-world conditions of standing up from a bed or chair.
• This is often the first step before ordering more complex testing.

The tilt table test provides a more controlled environment to monitor your vitals during position changes. You are strapped to a table that moves you from a horizontal position to a vertical angle while machines continuously monitor your heart’s reaction.

• Safety straps prevent you from falling if you faint.
• It allows for continuous, beat-to-beat monitoring of blood pressure.
• It can safely provoke symptoms in a controlled medical setting.

Techniques for managing POTS

Key points: While there is currently no known cure, effective POTS management focuses on increasing blood volume and retraining the autonomic nervous system to handle gravity better. Most treatment plans combine medication with significant lifestyle adjustments to improve daily function. It takes time and patience to find the right combination of interventions.

• Focusing on hydration can help fight against the low blood volume caused by POTS.
• Building cardiovascular strength through recumbent exercise can be helpful.
• Identifying and managing your triggers can give you more control over your daily life.
• Compression socks, leggings and abdominal binders can help reduce the pooling of blood in your legs and abdomen.

Fluids and hydration are the first line of defense against symptoms caused by low blood volume. Increasing salt intake helps the body retain fluid, which boosts volume and helps push blood up to the brain.

• Patients often aim for 2-3 liters of water daily.
• Electrolyte supplements can be more effective than plain water.
• High-sodium diets (often 3-10 grams of salt) are frequently prescribed.

Recumbent exercise allows patients to build cardiovascular strength without fighting gravity. Starting with rowing, swimming or recumbent biking helps avoid the heart rate spikes caused by standing upright.

• The Levine Protocol is a popular graded exercise program for this condition.
• Strengthening leg and core muscles acts as a natural pump for blood.
• Progression should be slow to avoid “crash” days.

Trigger management involves identifying and avoiding situations that make symptoms flare up unexpectedly. Common culprits include large meals, hot showers and prolonged standing in lines.

• Eating smaller, more frequent meals reduces blood flow diversion to the gut.
• Using a shower chair can prevent dizziness in the heat.
• Avoiding hot environments helps maintain blood vessel tone.

Compression garments act as a mechanical aid to squeeze blood out of the legs and abdomen. High-waisted medical-grade tights are generally more effective than simple knee-high socks.

• Abdominal binders can be particularly helpful for some patients.
• Compression levels of 20-30 mmHg or higher are usually recommended.
• Putting them on before getting out of bed maximizes their benefit. 

Find a POTS doctor at INTEGRIS Health 

Moving forward: Finding a healthcare provider who understands dysautonomia is crucial for your recovery journey. Our specialists can help guide your treatment plan and get you back to doing what you love. 

This article was medically reviewed by Aleicia Mack, D.O., a cardiologist with the INTEGRIS Health Heart Hospital in Oklahoma City.  

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