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Postural tachycardia syndrome (PoTS) is an abnormal increase in heart rate after sitting or standing up. It typically causes dizziness, fainting, sweating and other symptoms.
There are many possible causes of PoTS, but in many cases the condition is unexplained.
It's sometimes known as postural orthostatic tachycardia syndrome.
Normally when you sit or stand up, some of your blood drops under gravity to your belly area, hands and feet.
In response, your blood vessels quickly narrow and your heart rate increases slightly to maintain blood flow to the heart and brain, and prevent blood pressure dropping. This results in a slight increase in blood pressure.
This is all done without needing to think about it by the autonomic nervous system – the nervous system in charge of automatic body functions such as this.
In PoTS, for some reason the autonomic nervous system doesn't function properly. There's a drop in blood supply to the heart and brain when you become upright.
In an attempt to compensate for this, the heart races and the body produces lots of the hormone noradrenaline (one of the hormones that prepares you for "fight or flight").
Some people with PoTS just have mild symptoms, but others can be severely affected and find it significantly impacts on their day-to-day life (although the condition is not life threatening).
Typical symptoms are:
It's easy to mistake these symptoms for signs of low blood pressure, but blood pressure doesn't necessarily fall in PoTS.
If you think you may have PoTS, see your doctor. Some doctors may not be aware of the condition, so it may be helpful to print out this page to take with you to the consultation.
Symptoms can be managed with lifestyle changes and, if necessary, medication.
In many cases, the cause of this nervous system problem is not known.
Teenagers will sometimes develop PoTS after a growth spurt and find it gradually disappears a few years later.
It can also develop later in life – typically at any age from 15 to 50 – and is much more common in females. It can develop suddenly after a viral illness or traumatic event, or during or after pregnancy.
Some of the other known causes are:
PoTS can be misdiagnosed as chronic fatigue syndrome](https://www.your.md/condition/chronic-fatigue-syndrome), [anxiety or panic attacks.
A diagnosis of PoTS is made if your heart rate increases by 30 beats per minute (bpm) or more (40bpm in those aged 12 to 19) after 10 minutes of standing, or if it increases to more than 120 bpm.
By definition, this happens with no drop in blood pressure.
Heart rate is usually measured during the active stand test or the tilt table test.
This test is carried out in a hospital outpatient department and involves lying flat on a special bed with a footplate.
The bed is tilted upright to about 60-75 degrees for up to 45 minutes and any symptoms are observed.
Some people with PoTS briefly faint when upright, but you'll be in safe hands. Blood pressure and heart rate are recorded continuously.
You may be given medication to take during the test.
You may also have any of the following tests:
You may be able to improve PoTS symptoms by following this advice:
Some people with PoTS may need to increase their daily salt intake, but this is not recommended if you have high blood pressure or kidney or heart disease. Your specialist will advise on this.
If you do suddenly feel faint or dizzy, try countering the fall in blood flow by:
If a medicine seems to be worsening your PoTS, speak to your doctor about switching to an alternative medication, but never come off it without seeking medical advice.
There is currently no medication licensed for the treatment of PoTS, but your specialist might suggest trying a medication "off label", such as:
Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.