Symptoms of POTS include feeling faint, lightheadedness, the sensation that the heart is pounding, blurred vision and fatigue.
Postural orthostatic tachycardia syndrome (POTS) is defined by a “constellation of signs and symptoms,” rather than any one characteristic, according to Marshfield Clinic Health System cardiologist Dr. Kelley Anderson.
“It’s a disorder where, when a person stands up their heartbeat goes up at least 30 beats per minute, and their blood pressure does not go down,” Anderson said. Symptoms include feeling faint, lightheadedness, the sensation that the heart is pounding, blurred vision and fatigue. Most symptoms occur when the affected person is standing.
“These symptoms are very common,” Anderson cautioned. “It’s not always POTS causing these symptoms.”
Diagnosing POTS
If no other cause can be identified for this collection of symptoms, POTS is a possible diagnosis.
“You’re excluding other causes, and, over time, you can narrow it down to a diagnosis of POTS,” Anderson said. There is no definitive test that confirms a person has POTS.
POTS usually occurs in teens and young adults, ages 15-25, with 75 percent of the affected population being women. It occurs in about two of every one thousand people.
What causes POTS?
“Some people with POTS have a defect in the nerves that work with blood vessels,” Anderson said. “If those nerves aren’t working well, they won’t squeeze the blood vessels well enough, and when people stand up, blood has more difficulty getting to the heart.”
These nerves can also be overactive, with too many nerve signals or hormones triggered, causing the heart rate to go higher than it should. Some people have POTS, Anderson said, because they are “deconditioned.”
“They haven’t been exercising much and they feel tired. Because they have less exercise their heart rate goes up more strongly whenever they increase their activity,” Anderson said. “Over time they feel even more tired because they haven’t felt good enough to exercise, and it can be kind of a vicious cycle.”
Prognosis
“If you have the symptoms, your quality of life can be very bad because you feel terrible,” Anderson said. Some people with POTS are unable to work due to the severity of their symptoms.
Fortunately, it is not fatal, and it usually gets better and goes away over time.
Treatment options
Lifestyle changes can make a big difference for people affected by POTS.
“Daily, regular exercise is essential for most patients,” Anderson said.
Anderson advises staying well-hydrated and adopting a diet heavy in salt because salt helps increase the volume of blood in a person’s body. Wearing compression stockings also can be helpful for some patients. Finally, if other options fail, symptoms can be relieved with medication.
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Hi I noticed that the cardiologist in this page that pots patenients blood pressure doesn't fall however I've had pots for the last 7 years and my blood pressure drops a lot and I also have cardiogenetic syncope and usually have a lot of chest pain with it is this normally to have with pots
Hi, Natasha. We can't provide individualized medical advice on this forum. If you are a Marshfield Clinic patient, I would suggest messaging your doctor through My Marshfield Clinic to address your questions regarding the history you've had with POTS, cardiogenic syncope and chest pain: http://www.marshfieldclinic.org/MyMarshfieldClinic. -Kirstie
Hi Kirstie
Thank you for your advice however I live in Northern Ireland so I cannot attend this clinic as there isn't one over here which is why I was asking for advice as it is very well known over here. But thank your for replying
Natasha
Natasha – Your current doctor should also be able to answer these questions for you. Additionally, this article from the U.S. National Library of Medicine may help: "They suggest the left sided heart pain common among POTS sufferers is due to differences in heart chamber pressures, abnormal heart wall motions, and/or nerve damage. However, based on the study the chest pain may be associated with reduced blood supply to the heart, hence ischemia, which will result in the angina like chest pain."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390096/
I hope this helps, and thank you for reading. -Kirstie
How does this differ from Neurocardiogenic Syncope? Symptoms sound similar. Could I have both?
Hi, Susan. Dr. Anderson said, "In Neurocardiogenic syncope the BP goes down and/or the heart rate goes down and the patient collapses and is usually at least briefly unconscious. In POTS the heart rate goes up and there is generally not much change in BP. They are quite different but there are probably individuals who have had both."
Please talk to your doctor about your specific questions and concerns regarding POTS and NCS; we cannot give individualized medical advice on this forum. -Kirstie
Is a rapid heart beat always a symptom with this? Have been lightheaded and fatigued and leg cramps.
Hi, Nancy. Tachycardia actually means “an abnormally rapid heart rate.” Though the other symptoms vary – feeling faint, lightheadedness, pounding heart, blurred vision, fatigue — an increased heartbeat is consistent in POTS. As Dr. Anderson mentions in the story, “These symptoms are very common. It’s not always POTS.” We cannot give individualized medical advice on this forum. Contact your primary care doctor so you can work together to address your symptoms. -Kirstie
How does this differ from orthostatic tremor, one of my current diagnoses? I have a history of heart failure due to viral cardiomyopathy in 1992. My current regimen includes diuretics and a low salt diet; plus no more than 2 liters of fluid daily. Standing still very difficult; need to use rollator or cane to get around.
Hi, Margaret. I discussed the difference between orthostatic tremor and POTS with Dr. Anderson. He said: In orthostatic tremor, difficulty standing is caused from tremors in the legs. In POTS, people have difficulty standing because of lightheadedness and fainting accompanied by rapid increase in heartbeat. This source may help you better understand the difference: https://www.orthostatictremor.org/ot-glossary.html
We cannot provide individualized medical advice on this forum. Please discuss specific questions with your primary care provider. If you are a Marshfield Clinic patient, you can use My Marshfield Clinic’s messaging: http://www.marshfieldclinic.org/MyMarshfieldClinic.