POTS and dysautonomia
Postural orthostatic tachycardia syndrome
Chronic conditionA problem with the nervous system's control of heart rate and blood flow. When you stand, your heart races and you may feel dizzy, foggy, or faint.
Medical Disclaimer
For education only — this guide can't diagnose you. If these signs sound familiar, talk with a healthcare provider. Book a consult
What happens
The autonomic nervous system controls things you don't think about, such as heart rate, blood pressure, and digestion. Dysautonomia means this system isn't working smoothly. In POTS, blood pools in the legs and belly when you stand, and the heart speeds up to make up for it. POTS is diagnosed when your heart rate rises by 30 beats per minute or more within 10 minutes of standing, without a large drop in blood pressure, and symptoms last at least 3 months. It often starts after an infection, pregnancy, surgery, or a concussion. It's also common with hypermobility and long COVID.
Who gets it
About 80% of people with POTS are women, most often between the ages of 15 and 50. Symptoms can worsen around your period and change during pregnancy. POTS is more common with hypermobile Ehlers-Danlos syndrome, mast cell activation syndrome, and after viral illnesses, including COVID-19.
Signs worth getting checked
- A racing or pounding heart when standing
- Dizziness or lightheadedness, especially after standing up
- Fainting or nearly fainting
- Brain fog and fatigue
- Shakiness, sweating, or chest discomfort when upright
- Purple, pooling color in the legs when standing
- Nausea, bloating, or other digestive symptoms
- Trouble tolerating heat, long showers, or standing in line
Labs to ask about
- An active stand test, with heart rate and blood pressure checked lying down and after standing for up to 10 minutes
- A tilt table test if the stand test isn't clear
- ECG, and sometimes a heart monitor or echocardiogram
- CBC and ferritin to check for anemia and low iron
- TSH, metabolic panel, and morning cortisol to rule out other causes
Treatments your doctor may discuss
- More fluids, often 2 to 3 liters a day, and extra salt as your doctor advises
- Waist-high compression stockings or an abdominal binder
- A gradual exercise program that starts lying down or seated, such as rowing, swimming, or a recumbent bike
- Medicines such as low-dose beta blockers, fludrocortisone, midodrine, ivabradine, or pyridostigmine
- Treating related conditions, such as low iron, hypermobility, or mast cell symptoms
Supportive steps to discuss with your provider
- Drink 2 glasses of water before getting out of bed in the morning.
- Stand up slowly, and sit or lie down at the first sign of feeling faint.
- Eat smaller, more frequent meals and limit alcohol.
- Cross your legs or clench your thighs and buttocks when you have to stand still.
- Raise the head of your bed slightly and keep cool in hot weather.
See a doctor promptly if you have
- Chest pain, fainting with injury, or fainting during exercise: call 911
- A racing heart with shortness of breath or confusion: go to the emergency room
- Fainting more often, or fainting without warning
- Vomiting or diarrhea that keeps you from staying hydrated
- Symptoms that keep you from work or school
Related conditions
Ready to find the root cause?
Dr. Lesher is a Naturopathic Doctor who focuses on autoimmune and chronic conditions in women. Since 2020, she's helped hundreds of patients stop managing symptoms and start healing.