Understanding POTS symptoms: Common signs you shouldn't ignore

If you’ve ever felt your heart race, lightheadedness and fading vision like you’re going to pass out just by standing in line at the grocery store, there might be an explanation: Postural orthostatic tachycardia syndrome, commonly known as POTS.

Let’s take a closer look at what exactly POTS is, what causes it, and how it’s diagnosed.

What is POTS?

Postural orthostatic tachycardia syndrome is a condition that affects the autonomic nervous system—the part of your body that controls automatic functions like heart rate, blood pressure and digestion. While the name sounds complicated, the core issue is relatively straightforward: your body struggles to properly adjust when you’re standing up.

Standing shouldn't feel like you’ve just run a marathon, but for people living with POTS, it often does. But POTS is not to be confused with orthostatic hypotension. Orthostatic hypotension is very common. This happens if you stand up too fast and feel dizzy, but the difference is that it resolves after a few seconds.

With POTS, you could be standing in that very line at the grocery store and suddenly feel your heart race, feel lightheaded, have issues with your vision and even feel like you’re going to pass out. It typically will resolve if you sit down.

This isn't simply feeling lightheaded for a moment. POTS is a chronic condition that can significantly impact daily life, affecting an estimated one to three million Americans, with women between ages 15 and 50 being disproportionately affected.

POTS symptoms: What to look out for

The hallmark symptom of POTS is a rapid heartbeat while standing, but the condition manifests in numerous ways that can vary significantly from person to person. Here are the most common symptoms to watch for:

• Cardiovascular symptoms are often the most noticeable. People living with POTS frequently experience heart palpitations or a pounding sensation in their chest, especially when upright. This rapid heartbeat can feel alarming and may be accompanied by chest discomfort or shortness of breath.
• Dizziness and lightheadedness occur because blood flow to the brain decreases when standing. Some people experience pre-syncope (feeling like you're about to faint) or actual fainting episodes, though not everyone with POTS loses consciousness. The room might seem to spin, or you might feel unsteady on your feet.
• Fatigue is perhaps one of the most debilitating aspects of POTS. This isn't ordinary tiredness—it's exhaustion that doesn't improve with rest. Many people describe feeling completely drained after activities that once seemed effortless, like showering or walking to the mailbox.
• Brain fog makes concentration and clear thinking difficult. People with POTS often struggle with memory, have trouble finding words or feel mentally sluggish. This can be particularly frustrating and may worsen when standing or during symptom flare ups.
• Additional symptoms can include headaches, nausea, shakiness or tremors, excessive sweating or feeling unusually cold, visual disturbances like blurred vision or seeing spots, and difficulty exercising. Some people also experience gastrointestinal issues such as bloating, constipation or abdominal pain.

The severity and combination of symptoms can fluctuate day to day or even hour to hour, making POTS particularly challenging to manage and sometimes difficult for others to understand.

You may have even heard that there are more cases of POTS due to long COVID, but more research is needed.

How is POTS diagnosed?

Diagnosing POTS requires more than just recognizing symptoms—it involves specific testing. These include the following (both performed by a medical professional):

• Tilt table test: You lie on a table that tilts upward to simulate standing while your heart rate and blood pressure are monitored.
• Active stand test: Your vital signs are measured while lying down, then continuously monitored as you stand for up to 10 minutes.

A diagnosis of POTS is typically made when heart rate increases by at least 30 beats per minute (or to over 120 beats per minute) within 10 minutes of standing, without a significant drop in blood pressure, and you’ve been experiencing symptoms for at least three months.

Your doctor will also want to rule out other conditions that can cause similar symptoms, which may involve blood tests, heart monitoring and reviewing your medication list.

Treatment options: What works for you?

While there's no cure for POTS, many people find significant relief through a combination of treatments tailored to their specific symptoms and triggers.

Lifestyle modifications form the foundation of POTS management. Here are some things that help:

• Increasing fluid intake—often to two to three liters daily—helps expand blood volume.
• Boosting salt intake (with your doctor's approval) also helps retain fluid and maintain blood pressure.
• Wearing compression stockings can prevent blood from pooling in the legs.

Exercise, though challenging, is crucial. A carefully structured exercise program can improve symptoms over time:

• Start with recumbent or horizontal exercises and gradually increase intensity.
• Work with a physical therapist experienced in POTS to make this process more manageable.

Dietary changes help many people.

• Eating smaller, more frequent meals can reduce blood flow shifts to the digestive system.
• Limiting alcohol and being mindful of carbohydrate intake helps manage symptoms.

Medications may be considered for treatment as well:

• Beta-blockers to slow heart rate
• Mineralocorticoids to help retain sodium and expand blood volume
• Vasoconstrictors to tighten blood vessels
• Heart rate-lowering medications that work without affecting blood pressure

Your doctor will determine which medications might be appropriate for your health.

Living with POTS symptoms: Support is out there

Living with POTS can feel isolating, especially because the condition isn't always visible to others. On difficult days, remember that your symptoms are real, and there are treatment options that can help. Many people with POTS find ways to manage their symptoms effectively and maintain fulfilling lives.

If you think you might be living with POTS, don't hesitate to speak with your doctor. Early diagnosis and treatment can make a significant difference in your quality of life. And if you're already living with POTS, know that ongoing research continues to improve our understanding of this condition and expand treatment options.

Whether you're just beginning to understand your symptoms or you've been navigating POTS for years, connecting with others who understand—through support groups or online communities—can provide valuable insights and emotional support.

Experiencing POTS symptoms? Find a primary care provider near you.