Postural orthostatic tachycardia syndrome (POTS): Causes, symptoms, treatment, diet and exercise

POTSPostural orthostatic tachycardia syndrome (POTS) is a heart rate that accelerates when you stand up. This condition can take effect up to 10 minutes after standing up. This condition prevents the body from controlling blood pressure and heart rate as it normally would, stopping blood from getting to the brain. This often results in dizziness and the feeling of being lightheaded. Some patients faint when this happens, and sitting or lying down helps relieve the sensation. For many people suffering from this condition, the symptoms of POTS can make it challenging to keep up with daily living.

Here is a breakdown of each word in the name:

  • Postural: The condition relates to the posture of the body.
  • Orthostatic: Suggests the body’s position is involved and refers to a sudden drop in blood pressure as well as dizziness.
  • Tachycardia: Defined as a rapid heartbeat, generally exceeding 100 beats per minute (bpm).
  • Syndrome: Meaning the condition is not a disease, but a group of symptoms often seen together.


Also read: Resting heart rate chart: Factors that influence heart rate in elderly

What are the causes and symptoms of POTS?

Aside from the rise in heart rate when standing, someone with POTS may experience a variety of additional symptoms.

Some other symptoms of postural orthostatic tachycardia syndrome include:

  • Elevated heart rate within 10 minutes of standing
  • Decreased blood pressure
  • Pain in hands and feet
  • Lightheadedness
  • Fatigue
  • Heart palpitations
  • Exercise intolerance
  • Tremors or shaking
  • Chest pain
  • Shortness of breath
  • Inability to concentrate
  • Pain or coldness in extremities
  • Bloating
  • Constipation
  • Nausea
  • Diarrhea
  • Weakness

Scientists are still unsure of exactly what causes postural orthostatic tachycardia syndrome, but some researchers believe the condition is more likely to occur immediately after the following events:

  • Severe illness
  • Injury
  • Major surgery
  • Trauma
  • Anything that causes changes in the way the heart functions, or the blood vessels
  • Damaged nerves or impacted nerve function in the legs and feet
  • Prolonged periods of increased fight-or-flight responses

Researchers have also identified some underlying conditions and diseases that frequently occur in people with POTS.These include the following:

  • Diabetes or prediabetes
  • Autoimmune diseases
  • Deconditioning or prolonged bed rest
  • Epstein Barr virus
  • Lyme disease
  • Mononucleosis
  • Ehlers Danlos syndrome
  • Vitamin and mineral deficiencies, including anemia

How to diagnose postural orthostatic tachycardia syndrome

Any person concerned that they have POTS should keep a detailed record of their symptoms. To get a diagnosis for postural orthostatic tachycardia syndrome, you will need to see your doctor. You can review the symptoms with them and they will likely assess your overall health to confirm your condition. Depending on your symptoms, your doctor may refer you to a cardiologist or neurologist for additional testing to see if you meet the diagnostic criteria for POTS.

Diagnosis may include a tilt table test, electrocardiogram (ECG), or an active stand test. To get a confirmed diagnosis, you must have symptoms of orthostatic intolerance and meet the following criteria below:

  • People aged 19+ must have an increase in heart rate of 30 bpm minimum within five minutes of standing up.
  • People aged 12–19 must have an increased heart rate of 40 bpm minimum within five minutes of standing.
  • Symptoms must be consistent for at least six months.

Treatment for postural orthostatic tachycardia syndrome

Treatments for POTS may vary for each patient, depending on the condition type, severity, and cause. When it is caused by an underlying condition like diabetes, treatment can focus on managing that specific condition. Treatment options can include the following options:

  • Medication
  • Medical compression stockings
  • Blood pressure monitors
  • Cardiac rehab program
  • Diet and nutritional changes
  • Isometric exercises, simple yoga, modest walking programs
  • Adequate and quality sleep

Other options for treatment include physical therapy, medication, and lifestyle changes. Physical therapy is generally the best treatment option out of the three. A physiotherapist can help you gradually recondition your body to function more efficiently. One of the exercises used in this kind of therapy include gentle resistance training, which strengthens the skeletal muscle pump and helps the heart to circulate blood through the body. If physical therapy and lifestyle changes are unable to relieve the symptoms, medication may be the next treatment option.

Medication is used to stabilize the patient so they can begin the reconditioning program, though it isn’t intended to be a permanent or long-term treatment.

Diet and exercises to treat postural orthostatic tachycardia syndrome

Treatment for POTS is not intended to be permanent, but to help the patient’s body function normally again. The following diet, nutrition, and exercise tips are meant to manage and treat POTS.

Diet and nutrition

  • Increase sodium in diet from 3,000 mg to 10,000 mg per day.
  • Drink two- to two-and-a-half liters of fluids per day, preferably water or sports drinks (watch out for calories or food sensitivities).
  • Small and frequent meals can reduce POTS symptoms and are more tolerable.
  • Eat a diet rich in fiber and complex carbohydrates to reduce blood glucose spikes and reduce symptoms.
  • Maintain a balanced diet with protein, vegetables, dairy, and fruits. Plan meals to incorporate healthier choices.
  • Do not consume too many processed foods, as they lack nutrients and contain unhealthy salts, preservatives, and other ingredients.
  • Have someone help you shop when you go to the grocery store.
  • Although healthy foods are more expensive, do not compromise to save money.
  • If you need help, consult a dietary and nutrition expert ordered by your doctor.
  • Be wary of fad diets and commercialized weight loss programs.

Exercise and physical activity

To managing POTS, exercise and physical activity are vital. Here are some important tips that can help you improve your health and manage your symptoms.

Isometric exercises

Involves contracting your muscles without moving your body. Isometrics squeeze the muscle and push blood toward the heart. They are simple enough to be done lying in bed or seated in a chair. These are good exercises to perform first thing in the morning to prepare your body for sitting and standing.

Transition slowly

For these exercises, patients are recommended to go from lying to sitting on the edge of the bed. After remaining in that position for several minutes, you can slowly stand. If you feel lightheaded at any point, wait a few minutes in that position to see if it resolves. If not, go back to the previous position, and slowly try again after a few minutes.

Begin a modest walking program


This walking program is designed to see how many steps you can walk without inducing symptoms. Start with walking once a day and go a little further in time, distance, or by adding steps. If you feel good, add a second walk into the day. Fitness trackers are helpful tools to monitor steps and distance. Gradually add more steps to your daily total.

Simple yoga

Focus on breathing and perform very gentle and slow moves. This may help reduce POTS symptoms.
As you reduce your symptoms of POTS, you can slowly take on more fitness and exercise regimens while involving yourself in more physical activities.



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