Signs and Symptoms of POTS

Postural orthostatic tachycardia syndrome (POTS) is a condition that causes your heart rate to speed up when you move from lying down or sitting to standing. As a result, you may experience symptoms such as dizziness, fatigue, and nausea. POTS tends to develop after you've experienced an illness, pregnancy, or major surgery.

People with POTS can have symptoms that tend to come and go. Periods of active or worsening symptoms are known as flare-ups or flares. Symptoms can also vary from person to person, so the condition can sometimes be difficult to treat. That's why knowing the symptoms of POTS is so important and can help you figure out when you need to reach out to your healthcare provider.

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Common Symptoms

The most common symptom all people with POTS experience is orthostatic intolerance, which means you start having symptoms when you go from a sitting position to a standing position. Your heart rate will usually increase by 30 beats per minute or more—sometimes going higher than 120 beats per minute. This can happen anytime from immediately after you stand up to as long as 10 minutes after standing.

For many people, when your heart rate goes up this high when standing, your blood pressure drops. Healthcare providers call this orthostatic hypotension. But when you have POTS, your heart rate goes up without your blood pressure going down, causing both a high heart rate and a higher blood pressure. You may find that your heart rate decreases when you lie back down.

You may also experience the following symptoms when you stand up:

  • Blurry vision
  • Irregular heart rhythms or heartbeat
  • Lightheadedness or dizziness
  • Difficulty tolerating physical activity
  • Weakness
  • Unexplained fatigue
  • Trouble thinking clearly
  • Anxiety or fear that you'll experience more POTS symptoms

Unfortunately, there's a lot that healthcare providers still don't know about POTS and its symptoms. However, they have described a few different types of POTS that can cause different symptoms to occur. It's possible to also have symptoms that belong to more than one type.

woman with POTS feeling dizzy
Antonio Diaz / Getty Images.

Symptoms of Neuropathic POTS

If you have neuropathic POTS, you may have a lower tolerance to heat. More than half of people with POTS tend to have trouble sweating in their legs. You may notice this symptom when you're outside in the heat and your legs aren't sweating, which may keep you from cooling off as quickly.

However, those with neuropathic POTS report fewer incidences of anxiety and depression compared with those who have other POTS subtypes.

Symptoms of Hyperadrenergic POTS

An estimated 30% to 60% of people with POTS have hyperadrenergic symptoms. If you have this subtype, you will usually have higher levels of a neurotransmitter (a chemical messenger in your brain) known as norepinephrine. As a result, your heart rate tends to go up much higher than a person with a different type of POTS.

Additional hyperadrenergic POTS symptoms include:

  • Excessive sweating
  • Nausea
  • Heart palpitations
  • Shaking or tremors
  • Stomach pain

These symptoms may worsen when you exercise or feel really stressed.

Symptoms of Volume Dysregulation

A less common POTS subtype, those with volume dysregulation tend to have constantly low amounts of fluid in their body. When you don't have enough fluid (a condition called hypovolemia), changing positions from sitting to standing is more likely to cause your heart rate to go up.

POTS related to volume dysregulation may also affect the functioning of your kidneys and endocrine system (the system in your body that controls your hormones). Because your kidneys control how much fluid you release through your urine, this type of POTS can affect the fluid levels in your body and worsen POTS symptoms.

Symptoms of Mast Cell Activation Disorder

The mast cell activation disorder subtype of POTS isn't as well understood or researched. However, early studies show that this subtype may cause an excessive release of histamine, a compound that your body releases during a severe allergic reaction. As a result, you may experience symptoms such as:

Symptoms in Children

An estimated 33% of people with POTS experience symptoms before they turn 18. Symptoms of POTS in children can often mimic the symptoms adults experience, including:

  • Dizziness
  • Fatigue
  • Headache
  • Nausea
  • Shortness of breath
  • Sweating
  • Higher resting heart rate than adults
  • Difficulty exercising or participating in activities
  • Anxiety or irritability
  • Fainting
  • Trouble concentrating

Symptoms in Women

POTS symptoms affect women in more significant numbers than men. Women may notice their POTS symptoms worsen before their menstrual periods or after pregnancy, potentially due to hormone fluctuations. Research shows that women may also experience POTS symptoms earlier in life than men and have additional symptoms such as stomach aches, muscle weakness, and numbness in the hands and feet.

When to See a Healthcare Provider

POTS is a difficult condition to diagnose, which is why most people report seeing an average of seven healthcare providers before receiving an accurate diagnosis. If you think you may have POTS or may be at risk for developing the condition, it's a good idea to see your healthcare provider. You should reach out to your provider for care if you experience the following symptoms:

  • Increase in heart rate when standing
  • Unexplained fatigue or dizziness
  • Symptoms that get better when you lie down

Currently, the condition is difficult to diagnose because there is not enough research on POTS. However, as research continues, healthcare providers are becoming better equipped to diagnose and treat the condition.

A Quick Review

POTS is a condition that causes your heart rate to increase when standing. As a result, you may have symptoms such as irregular heart rhythms, dizziness, nausea, and fatigue. Your symptoms can also depend on the type of POTS you have. Some subtypes of POTS can cause trouble sweating, while other types may lead to an upset stomach.

If you think you have POTS or notice changes in your heart rate, it's a good idea to see your healthcare provider for proper testing to find out what is causing your symptoms.

Frequently Asked Questions

  • Is POTS a serious condition?

    POTS symptoms can vary. Some people may experience serious, complicated symptoms such as extreme fatigue, while others report mild symptoms.

  • What causes a POTS flare-up?

    You might notice symptoms of POTS flaring up after surgery, injury, a viral illness (e.g., COVID-19), or pregnancy.

  • What foods aggravate POTS?

    Foods don't necessarily make POTS worse, but some people with POTS may consume higher amounts of salt or water to increase the fluid balance in their bodies to help reduce symptoms.

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  2. National Institute of Neurological Disorders and Stroke. Postural Orthostatic Tachycardia Syndrome (POTS).

  3. Vernino S, Bourne K, Stiles L, et al. Postural tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part I. Auton Neurosci. 2021;235:102828. doi:10.1016/j.autneu.2021.102828

  4. Boris J. Postural orthostatic tachycardia syndrome in children and adolescents. Auton Neurosci. 2018;215:97-101. doi:10.1016/j.autneu.2018.05.004

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