Postural Orthostatic Tachycardia Syndrome


Postural Orthostatic Tachycardia Syndrome

POTS (= Postural Orthostatic Tachycardia Syndrome) has been briefly described as a defect in the autonomic nervous system. This means that all functions in the body that you have no control over are disrupted, with the main complaint being the significant increase in heart rate when standing / walking.

The term dysautonomia is an umbrella term for many autonomic dysfunctions, so not only POTS but also OH (= orthostatic hypotension) and OI (= orthostatic intolerance). POTS has several subdivisions and can come in a few different types: Hyperadrenergic POTS and Secondary POTS.

POTS is increasingly common and is mainly associated with rare conditions.

Although POTS is not that rare, it is unrecognized or insufficiently known by doctors.

Dysautonomy (POTS) is currently still under investigation as the treatment methods, mainly in America and therefore the available literature is often described in English.

There is also still much debate about the origin and cause of POTS as well as the treatment options for POTS.

Some treatments are only indications that may help some patients that are not (yet) included in the literature and are only experiences during studies with POTS patients.

The path to the right diagnose...

Here is a list of symptoms:

  • Tachycardia (high heart rate when standing / walking but can also persist in a lying position and even at night), also palpitations and / or tremors

  • Bradycardia (slow heart rate) can also occur

  • Low / high blood pressure fluctuations when standing / walking

  • (Pre) syncope / unwell / fainting

  • Fatigue

  • Loss of cognitive ability (brain fog)

  • Dehydration caused by low blood volume

  • Problems with temperature regularization of the body

  • Breathing problems equating complaints such as with a panic attack

  • Digestion problems

  • Deconditioning (by lying down for a long time)

  • ...

The main symptom of POTS is that the heart beats at least  30 SPM faster then the average and deviates from the normal by standing/walking or laying down position (abnormal increasing).

Finding the right doctor is difficult because POTS is not well known, many walk from one consultation to the other but are not helped. 

Which doctor can help me if I suspect I have POTS?

The doctors according to these specialties are most often mentioned:

* Cardiologist

* Internists

How can my doctor diagnose POTS?

The main test is the tilt table test (TTT) / tilt table test.
Measuring a few criteria such as a worsening of symptoms when standing / walking, blood pressure drops by 20/10 within three minutes while standing and the symptoms improve when the patient lies down again.
Other possible disorders / causes must also be ruled out!
A typical symptom that may resemble POTS such as dehydration should also be excluded, although dehydration is also a POTS symptom.

Be sure to bring the information brochure that you will find on our download page on this website!

What treatments are available for POTS?

There is no concrete medicine yet to control or cure POTS, the condition is still under investigation and is not yet fully known.
There are few medications available that can help POTS patients to help control / reduce symptoms in order to regain quality of life.

  • Drinking electrolyte drink / fluids, take up to 2.5- 3 liters per day and 10 to 8-10-12 grams of salt

  • Fludrocortisone:
    Increased blood volume and regulates the salt and fluid balance + blood pressure

  • Beta blocker: reduces heart rate

  • Compression clothing / support stockings: this is to prevent blood pooling in the lower part of the body. Choose class 2 compression stockings or clothing.

  • Cardiovascular training: it can help you to recondition when you have been lying flat for a long time due to the condition in order to make your body function again under gravity.

  • Therapeutic exercises that eliminate gravity can be a good start to rehabilitation such as swimming.

  • Medical aids can help such as a shower chair, mobility aids; portable stools and chairs.

Selfdiscipline is very important for POTS, it takes a lot exercise and training! 

Some factors can worsen or flare up POTS such as heat (hot shower or bath), eating a heavy meal, becoming dehydrated, standing for a long time, consuming alcohol and carbohydrates, using caffeine / energy drink.


Measurings with an Apple smartwatch

Download the information brochure that's available for general practitioners

The relation between Dysautonomia & Covid-19

Is there a connection of getting POTS after Covid19?

POTS can be caused by a variety of conditions, including viral or bacterial infections. Some researchers believe that coronavirus may be a trigger for POTS as an increasing number of people who recovered from COVID-19 are now experiencing POTS-like symptoms such as brain fog, tachycardia (increased heart rate) and severe chronic fatigue. This similarity in symptoms prompted doctors to test patients for POTS.

The autonomic nervous system regulates functions that we do not consciously control, such as heart rate, blood pressure, sweating and body temperature. Faults in any of these areas can cause symptoms that can be shared by numerous conditions. Doctors unfamiliar with POTS can dismiss these symptoms as lingering effects of COVID-19 - or even psychological symptoms.
At the same time, POTS can be very debilitating and require specific treatment, so an accurate diagnosis is vital.

International Dysautonomia Support Group