Conditions We Treat
Postural Orthostatic Tachycardia Syndrome (POTS)
Postural Orthostatic Tachycardia Syndrome (commonly known as POTS) is a condition that affects the autonomic nervous system, leading to an excessive increase in heart rate when moving from a lying down to a standing position.
POTS has been estimated to affect as many as 200,000 Australians, yet is an invisible illness that often remains undiagnosed or misdiagnosed. It is more common in women and those assigned female at birth, and often develops in adolescence and young adulthood. POTS can cause a range of symptoms that can severely impact daily activities and overall quality of life.
What causes POTS?
The exact cause of POTS is not fully understood, but it is believed to involve a combination of genetic, environmental, and physiological factors, including:
Genetic Predisposition: Family history of POTS or related conditions.
Viral Infections: Previous infections that may trigger the onset of POTS - including influenza, glandular fever/Epstein Barr, or more recently, COVID-19. POTS is thought to be one of the underlying contributors to Long COVID syndrome.
Autoimmune Disorders: Conditions where the immune system mistakenly attacks the body.
Hypermobility Disorders (HSD) and Ehlers-Danlos Syndrome (EDS): rates of dysautonomia are much higher in hypermobile groups, though this isn’t yet well understood.
Prolonged Bed Rest: Extended periods of immobility, such as after surgery or illness, can bring on POTS-like symptoms.
What’s actually happening when I have POTS symptoms?
Many of the symptoms of POTS worsen in upright positions. This is called “orthostatic intolerance”. We still don’t fully understand the complexities of POTS, but a few key mechanisms have been suggested that may cause symptoms:
Low Blood Volume (hypovolaemia): Many individuals with POTS have low blood volume, which causes reduced blood pressure and reduces the amount of blood returning to the heart when standing up, leading to a rapid increase in heart rate to compensate.
Autonomic Nervous System Dysfunction (dysautonomia): The autonomic nervous system, which controls involuntary bodily functions like heart rate and blood pressure, may not respond properly to postural changes, causing an exaggerated heart rate response to standing. You can check out more about dysautonomia on our blog here
Excessive Venous Pooling: Blood may pool in the lower extremities due to abnormal blood vessel reflexes, which causes swelling and discolouration, and reduces blood flowing to the heart and brain. This triggers a compensatory increase in heart rate.
Hyperadrenergic State: Some POTS patients have high levels of norepinephrine, a hormone linked with the body’s sympathetic nervous system or “fight or flight” system. Norepinephrine stimulates an increase in heart rate and blood pressure, especially upon standing.
Immune System Abnormalities: Autoimmune mechanisms may play a role, with evidence of chronic systemic inflammation and autoantibodies in some POTS patients. POTS also frequently overlaps with autoimmune conditions like rhuematoid arthritis, lupus, Hashimoto’s Disease and Sjogren’s syndrome.
What are the symptoms of POTS?
POTS symptoms are often complex and affect many body systems!
Dizziness or lightheadedness: Particularly when standing up from a sitting or lying position.
Rapid heart rate (Tachycardia): heart rate is generally normal at rest, but increases excessively once moving to an upright position.
Palpitations/chest pain
Fatigue that doesn’t improve with rest
Drop attacks/fainting: while fainting (syncope) is possible, many people with POTS may not completely faint, but find they end up on the floor while maintaining consciousness.
Brain Fog: Difficulty concentrating, remembering, or thinking clearly.
Blotchiness/discolouration in the hands and lower legs
Nausea or upset stomach
Irritable Bowel Symptoms
Shortness of breath, especially upon standing.
Shakiness, tremors or a jittery feeling.
Strong salt cravings: sometimes people with POTS will crave salt instinctively, which could be the body’s response to attempt to correct low blood pressure. We’ve had patients tell us about eating salt straight from the shaker, or even stock cubes!
Generally, POTS symptoms are worse when in an upright position, but can also be made worse by hot weather, dehydration, stress, and general illness, among other triggers. Everyone is unique and may notice different things affect them more than others.
Commonly Associated Conditions
POTS is often seen alongside other medical conditions, including:
Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorders (HSD)
Autoimmune Disorders (e.g. Rhuematoid Arthritis, Sjogren’s Syndrome, Hashimoto’s Disease)
Mast Cell Activation Syndrome (MCAS)
Gastrointestinal Disorders & IBS
How is POTS treated?
There is no one-size-fits-all treatment for POTS, but a combination of therapies and lifestyle changes can help to better manage symptoms and improve functional tolerance over time. Common treatment approaches include:
Medication: There are a range of medications that can be trialled to help with POTS, including beta-blockers, fludrocortisone, and midodrine. Most medications aim to manage heart rate and blood pressure.
Physical Therapy: Tailored movement plans to pace and gradually increase activity can help build functional tolerance over time. This must be done carefully, and with flexibility to accommodate fluctuating symptoms and avoid flares of symptoms. Strength based exercise (especially in the legs) can also help with improving vascular return by improving the “muscle pump”.
Hydration and Diet: Increasing fluid and salt intake to boost blood volume is often helpful for POTS. Improvements to overall nutrition and support for gut health can also help to reduce symptoms, and some people may benefit from additional support to trial more specific anti-inflammatory/low-histamine diets, though research evidence for this is still inconclusive.
Compression Garments: Wearing compression stockings can help reduce blood pooling in the legs and improve blood flow, helping to reduce symptoms when standing.
Lifestyle Modifications & Trigger Management: Making changes to reduce triggers and the likelihood of POTS symptoms can be useful, such as avoiding prolonged static standing, pacing activity, elevating the legs, foot and ankle movements to help pump blood back to the heart, and keeping cool in hot weather.
Stress Management & Nervous System Regulation: Techniques that help to reduce the “fight or flight” system can help to calm POTS symptoms. This can include specific mindfulness or relaxation exercises, breathing techniques, or other ways to help reduce stress.