POTS: Understanding Symptoms, Causes, and Treatment

Postural Orthostatic Tachycardia Syndrome (POTS) is a complex condition affecting the autonomic nervous system. It disrupts the body’s ability to regulate blood circulation, leading to an abnormal increase in heart rate when transitioning to a standing position. This rapid heart rate, often accompanied by dizziness, fatigue, and “brain fog,” significantly impacts daily life, making even routine activities feel overwhelming.

POTS frequently overlaps with other chronic conditions like Myalgic Encephalomyelitis/Chronic Fatigue Syndrome(ME/CFS) and Long COVID, as these diseases share many symptoms, such as post-exertional malaise (PEM) and cognitive dysfunction. The comorbidity among these conditions suggests shared underlying mechanisms, offering valuable opportunities for research and treatment advancements.

What is POTS?

Postural Orthostatic Tachycardia Syndrome (POTS) is a type of dysautonomia, a condition where the autonomic nervous system doesn’t function properly. It is defined by an increase in heart rate of more than 30 beats per minute (40 bpm for those aged 12–19) within 10 minutes of standing, without a significant drop in blood pressure. While POTS is not considered life-threatening, its symptoms—such as dizziness, lightheadedness, and overwhelming fatigue—can severely diminish the quality of life, making everyday tasks a challenge for those affected. However, the life expectancy for individuals with POTS is similar to that of the general population.

POTS primarily affects blood flow and circulation, preventing the body from maintaining stable blood pressure and heart rate when upright. It is often a chronic condition, requiring ongoing management to mitigate its impact.

Types of POTS

POTS is not a one-size-fits-all condition. It can present differently based on the underlying POTS causes. Here are the three primary types:

• Neuropathic POTS: This type stems from nerve damage, particularly in the small fibers that control blood vessel function. Damaged nerves fail to constrict blood vessels effectively, causing blood to pool in the lower body upon standing.
• Hyperadrenergic POTS: This form is marked by excessive release of norepinephrine, a stress hormone that activates the body’s “fight-or-flight” response. Individuals with this type may experience severe palpitations, high blood pressure, and anxiety-like symptoms.
• Hypovolemic POTS: Characterized by low blood volume, this type results in reduced blood circulation, exacerbating symptoms like dizziness and fatigue. Hypovolemic POTS can sometimes overlap with other types, further complicating diagnosis and management.

Understanding the type of POTS an individual has is critical for tailored treatment and effective symptom management.

Causes of POTS: Triggers and Risk Factors

POTS is a complex condition with multiple potential triggers and contributing factors. While the exact cause is not always clear, some of the most common triggers include:

• Viral Infections: POTS has been linked to infections such as mononucleosis and COVID-19.
• Physical Trauma: Injuries, surgeries, or prolonged periods of immobility can disrupt normal autonomic function and may lead to POTS symptoms.
• Autoimmune Conditions: Conditions such as lupus, Sjogren’s syndrome, and other autoimmune disorders often coexist with POTS, indicating that an overactive immune response may contribute to its development.
• Genetic Predisposition: Family history may also increase the likelihood of developing POTS, although more research is needed to understand the genetic components.

POTS is often triggered by a combination of these factors, making its onset and progression highly individualized.

Who is Affected by POTS?

POTS primarily affects women aged 15 to 50, although it can also impact men and children. Studies indicate that women are four to five times more likely to develop POTS than men, suggesting hormonal factors may play a role.

Certain life events and health conditions can increase the risk of developing POTS, including:

• Viral Infections: Many POTS cases develop following illnesses such as the flu or COVID-19, often as part of Long COVID.
• Pregnancy: Hormonal changes during and after pregnancy can trigger the onset of POTS symptoms in some women.
• Autoimmune Conditions: Individuals with autoimmune disorders are at a higher risk due to potential immune system dysregulation.

Understanding the populations most affected by POTS is crucial for early detection and intervention.

Symptoms of POTS

POTS presents a wide range of symptoms that can vary in severity and frequency. These symptoms stem from the autonomic nervous system’s inability to regulate key bodily functions properly. Below is a breakdown of the primary and secondary symptoms commonly associated with POTS.

Cardiovascular Symptoms

POTS is most notably marked by cardiovascular challenges that arise when transitioning to an upright position. These symptoms result from the autonomic nervous system’s inability to regulate blood flow and heart rate effectively.

Neurological and Cognitive Symptoms

Beyond the physical strain, POTS significantly impacts neurological and cognitive function and is often described as equally, if not more, debilitating. So, what does POTS feel like? Many individuals describe it as a constant battle with fatigue, dizziness, and difficulty focusing.

POTS, ME/CFS, and Long COVID

POTS often overlaps with other chronic conditions, particularly Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Long COVID. These conditions share several debilitating symptoms, including severe fatigue, post-exertional malaise (PEM), and cognitive dysfunction.

• The surge in Long COVID cases has led to a notable increase in POTS diagnoses, suggesting that viral infections may play a critical role in triggering autonomic dysfunction.
• Understanding these connections is vital for advancing research and developing effective POTS treatment strategies. Through groundbreaking studies like the REMEDIAL project and the Linking brain blood flow, neuroinflammation, metabolism and hormones in ME, POTS and Long COVID project, we are exploring the intricate connection between ME/CFS, Long COVID (LC), and POTS to uncover effective treatments and improve lives.

How is POTS Diagnosed?

Diagnosing POTS typically involves a combination of specialized tests and evaluations. The Tilt Table Test is a primary diagnostic tool, monitoring heart rate and blood pressure changes as the patient transitions from lying to standing. A heart rate increase of more than 30 beats per minute within 10 minutes of standing often confirms POTS.

Additional diagnostic methods include blood and urine tests, which identify underlying conditions or nutrient deficiencies, and autonomic function testing, which assesses nerve responses and other involuntary functions.

Accurate diagnosis is crucial for effective management and appropriate POTS medication. If you suspect POTS, seek evaluation from a healthcare provider experienced in autonomic disorders.

Be Part of Advancing Chronic Illness Research and Care

Living with POTS can make everyday activities feel insurmountable, as one patient, Kate, described:

“POTS can make it feel as though you are running with all your might while wearing heavy sandbags attached to your ankles and simultaneously trying to breathe through a straw, yet you’re simply just standing in line.”

By supporting OMF, you become part of a global movement to advance research and care for individuals affected by these chronic conditions. Visit our research initiatives page to learn more about our efforts, or contribute directly to this vital work by making a donation. Together, we can bring hope and solutions to those living with POTS and related conditions.