Understanding Postural Orthostatic Tachycardia Syndrome (POTS)

Postural Orthostatic Tachycardia Syndrome (POTS) is a complex condition that affects the autonomic nervous system (ANS), which controls many automatic functions in the body such as heart rate, blood pressure, digestion, and temperature regulation. For people with POTS, the body has difficulty adjusting blood flow when moving from a sitting or lying position to standing. This leads to a rapid increase in heart rate, along with a range of symptoms that can significantly affect daily life.

How Does POTS Work?

Normally, when a person stands up, gravity pulls blood toward the lower body. The ANS compensates by narrowing blood vessels and slightly increasing the heart rate to maintain blood flow to the brain and heart. In people with POTS, this response is disrupted. Blood pools in the lower body, leading to reduced blood flow to vital organs. The body often releases adrenaline to compensate, which can cause an exaggerated heart rate response without addressing the underlying issue.

Common Symptoms of POTS

POTS symptoms vary between individuals but may include:

• Cardiovascular: Rapid heartbeat (tachycardia), palpitations, dizziness upon standing or exertion.

• Neurological: Brain fog, migraines, fainting.

• Digestive: Bloating, nausea, irregular digestion.

• Fatigue and Weakness: Persistent tiredness, difficulty with exertion or standing.

• Temperature Regulation: Excessive sweating or trouble sweating.

• Other Symptoms: Blurry vision, chest pain, shortness of breath, tingling sensations.

These symptoms can range in severity and may fluctuate over time.

Who Does POTS Affect?

POTS can affect anyone, but it is most common in teenagers and adults aged 15–50, particularly women, who are diagnosed up to five times more often than men. POTS may develop gradually or appear suddenly, often following viral illness (including COVID-19), surgery, trauma, hormonal changes, or significant stress.

POTS Treatment & Therapy Options

Triggers and Risk Factors

• Viral Infections: Illnesses such as COVID-19, Epstein-Barr virus, and mononucleosis.

• Physical Trauma: Surgery, concussions, or injury disrupting ANS function.

• Concussion/TBI: Around 20% of concussion cases may lead to POTS, with equal risk across genders.

• Hormonal Changes: Shifts affecting blood volume, circulation, and autonomic regulation.

• Autoimmune Conditions: Some evidence suggests an autoimmune component, with relevant antibodies found in POTS patients.

• Genetics: A family history of POTS may indicate a genetic predisposition.

Associated Conditions

Several health conditions are linked to an increased risk of POTS, including:

• Ehlers-Danlos Syndrome (particularly the hypermobile type)

• Mast Cell Activation Syndrome

• Chronic Fatigue Syndrome

• Autoimmune diseases

• Diabetes and prediabetes

• Multiple sclerosis

Diagnosis

Diagnosis typically involves working with a cardiologist to rule out other cardiac conditions. The main diagnostic tools are the tilt-table test or a supine-to-stand test. A diagnosis is confirmed if the heart rate increases by at least 30 bpm within 10 minutes of standing, without a significant drop in blood pressure.

Living with POTS

Life with POTS can be difficult due to its invisible nature. Symptoms can interfere with work, social life, and everyday tasks like standing or walking. Many individuals feel misunderstood or dismissed, as symptoms are not always outwardly visible.

Managing POTS

Management strategies are often multifaceted and may include:

• Exercise: Gentle exercises like swimming or floor-based Pilates can support circulation. Programs can be tailored to individual needs and tolerance levels.

• Lifestyle Adjustments:

  • Increase hydration and salt intake (under medical supervision).

  • Use compression garments to reduce blood pooling.

  • Avoid prolonged standing and sudden posture changes.

• Fatigue Management: Use pacing techniques to balance activity and rest.

• Medication: May be prescribed to manage heart rate and vascular tone.

Advanced Therapies I use:

At the Brain Hub clinic, we integrate additional therapeutic options to support POTS patients:

• Vagal Nerve Stimulation (tVNS):

  • Non-invasive stimulation of the Vagus nerve to balance autonomic function.

  • May help reduce orthostatic intolerance and improve gastrointestinal symptoms.

• Photobiomodulation (PBM):

  • Enhances blood flow, reduces inflammation, and boosts cellular energy.

  • Can support tissue healing and autonomic regulation.

• Tilt Table Therapy:

  • Used diagnostically and therapeutically to improve tolerance to upright positions.

• Exercise Prescription:

  • Carefully monitored and structured to improve conditioning without worsening symptoms.

POTS is a complex condition with many potential triggers and associated challenges. While it can be difficult to manage, growing awareness and advances in research and therapy continue to offer hope. A comprehensive, personalised approach—which I offer and believe is essential—can significantly improve outcomes and quality of life for those affected.

See more about my approach to POTS at my YouTube link: Understanding POTS: Impact on Daily Life & Solutions