Postural tachycardia syndrome (PoTS) is an often overlooked condition that can cause debilitating dizziness and other symptoms, experts say. Characterized by an abnormal increase in heart rate upon standing, PoTS primarily affects the autonomic nervous system, which controls involuntary bodily functions such as heart rate, blood pressure, digestion, and sweating.
Individuals with PoTS typically experience a rapid rise in heart rate—usually by 30 beats per minute or more—within ten minutes of standing, without a corresponding significant drop in blood pressure. This abrupt increase can lead to symptoms including dizziness, a racing or pounding heartbeat, weakness, and in some cases fainting. Additional manifestations may include extreme fatigue, headaches, cognitive difficulties often described as “brain fog,” digestive issues, and abnormal sweating patterns.
The condition is believed to be underdiagnosed in primary care settings, partly due to limited awareness among general practitioners and its symptom overlap with numerous other causes of dizziness such as dehydration, low blood pressure, anemia, medication side effects, and inner ear disorders. A key distinguishing feature of PoTS is the positional trigger of these symptoms, which improve when the individual sits or lies down.
Diagnosis typically involves a simple test measuring heart rate and blood pressure while lying down and at intervals after standing. Increasingly, wearable devices such as smartwatches have provided patients and clinicians with valuable data demonstrating heart rate spikes during posture changes. Additionally, some patients may present with hypermobile joints, which can be a related clinical sign.
Treatment focuses on symptom management and lifestyle modifications. Increasing fluid intake to two to three liters daily is widely recommended to support blood volume and maintain blood pressure, while a higher salt intake may also be advised under medical supervision. Compression garments can reduce blood pooling in the lower body, easing the heart’s workload. When these measures prove insufficient, doctors may prescribe medications to regulate heart rate or improve blood volume and pressure, although no drugs are specifically licensed for PoTS in the United Kingdom; prescriptions are typically off-label and tailored to the individual patient.
Access to specialists skilled in managing PoTS remains inconsistent, potentially prolonging the diagnostic and treatment process. Experts emphasize that persistent or recurrent dizziness with a clear pattern related to posture should prompt patients to consult their healthcare provider about the possibility of PoTS, as early recognition and intervention can considerably improve quality of life.