Medically reviewed by Dr Nabila Laskar, Consultant Cardiologist (GMC 7040901). Postural tachycardia syndrome (POTS) is a disorder of the autonomic nervous system causing an excessive increase in heart rate on standing, typically rising by 30 beats per minute or more within ten minutes of moving from lying to standing. It is a significant cause of debilitating symptoms in otherwise young and apparently healthy people, predominantly women.
Symptoms occur on standing or prolonged upright posture and typically include a racing heart, dizziness or light-headedness, near-fainting or fainting, fatigue, brain fog, breathlessness, and heart palpitations. Symptoms often improve on lying down. The condition significantly impacts daily function, with many patients struggling to stand for extended periods, exercise, or carry out routine activities. POTS is frequently misattributed to anxiety, deconditioning, or functional disorder before the diagnosis is formally established.
POTS predominantly affects women of reproductive age, though it can occur in men and across age groups. Triggers include viral illness including post-COVID syndrome, pregnancy, trauma, and periods of prolonged bed rest or immobility. In some patients there is no identifiable trigger. Several subtypes exist, including hyperadrenergic POTS, which is associated with elevated noradrenaline on standing, and neuropathic POTS, caused by failure of the peripheral autonomic nervous system to appropriately constrict blood vessels in the legs on standing.
Diagnosis is established by demonstrating the characteristic heart rate rise on moving from lying to standing, confirmed by active stand testing or tilt table testing. A thorough cardiac assessment is important to exclude other causes of postural tachycardia, including inappropriate sinus tachycardia, dehydration, anaemia, or structural cardiac conditions. ECG assesses for underlying rhythm abnormalities and an echocardiogram evaluates heart structure and function. Blood tests assess thyroid function, cortisol, iron stores, and where indicated, standing noradrenaline levels.
Management is multimodal. Increased fluid and salt intake, compression garments for the lower limbs, and graded exercise rehabilitation form the non-pharmacological foundation and are effective for many patients. Where lifestyle measures are insufficient, medications to regulate heart rate, blood vessel tone, or blood volume are used depending on the suspected subtype. Multidisciplinary input from cardiology, neurology, and in post-COVID cases, specialist rehabilitation services, may be beneficial.
POTS is primarily a disorder of the autonomic nervous system affecting how the heart and blood vessels respond to changes in posture. Cardiac assessment is an important part of the workup to confirm the diagnosis and exclude structural cardiac causes.
Yes. Post-COVID syndrome is one of the most recognised triggers for POTS in recent years. Patients who develop sustained tachycardia, exercise intolerance, and postural symptoms following COVID-19 infection should be assessed for POTS.
Many patients improve significantly with appropriate management, particularly when triggered by a specific event such as illness or prolonged bed rest. Recovery timelines vary, and some patients require ongoing management.
No. You can self-refer to The Cardiology Doctors for assessment of postural symptoms and tachycardia without a GP letter.