Postural Tachycardia Syndrome (POTS)

When we stand up, the normal response is for our blood vessels to narrow and for our heart rate to slightly increase to maintain blood supply to our heart and brain. In POTS this automatic adjustment to upright position does not work correctly, resulting in the increased heart rate seen and an altered blood flow to the brain.

A man leaning against a wall holding one hand to his head

Postural Tachycardia Syndrome (POTS) is defined as a sustained (at least 30 seconds) increase in heart rate of 30 beats per minutes (in adults), within 10 minutes of standing accompanied by symptoms below with maintenance of normal blood pressure:

  • Light-headedness/dizzy on standing
  • Disorientation/imbalance
  • Fainting
  • Increased heart rate

POTS can be linked to hypermobility and also sympathetic nervous system over-activity.

For most people with POTS, their symptoms will improve with lifestyle changes and with self-management strategies. However those with more servere symptoms may require medication. Therefore, if you experience  POTS symptoms and have not been tested before, please speak to you GP for further investigations.

  • Managing Everyday Symptoms

    To manage day to day symptoms:

    • Keep hydrated: pale yellow/straw coloured urine
    • Elevate the head end of your bed, so you're not sleeping fully horizontal
    • Take care with temperature of bath/ shower, not too hot.
    • Experiment to see if having a shower or bath before bed rather than in the morning makes fatigue easier to manage and may also assist with sleep due to core body temperature gradient.
    • Try wearing support tights or other forms of compression clothing, to improve blood flow in your legs. Some GPs may be able to prescribe pressure garments of 30mmHg pressure which ideally needs to go waist high.
    • Avoid long periods of standing. If you need to stand in a queue crossing your legs, gently rocking from toes to heels or shifting weight from one leg to another can be helpful.
    • Allowing time in your morning routine to rise slowly after lying down; perhaps sit up in bed, drink a glass of water and perform ankle pump exercises.
    • Avoid drinking lots of caffeine or alcohol. Caffeine stimulates the nervous system and alcohol is a vasodilator exacerbating POTS symptoms.
    • Include more salt in your diet, however this is not advisable if you have high blood pressure or kidney or heart disease
    • Exercise: calf muscle strengthening exercise.

    YouTube video explaining management of POTS

  • Self-Management Strategies For Acute Episodes

    For acute episodes where you suddenly feel faint or dizzy; you can try countering the fall in blood flow by:

    • lying down and, if you can, raising your legs
    • Rocking up and down on your toes, clenching your buttocks and tummy muscles and/or clenching your fists if you're unable to lie down
  • Resources for POTS

    YouTube video:

    The basics for those newly diagnosed or awaiting diagnosis

    POTS UK online support groups: