What Is POTS?
Imagine the jolt of dizziness that hits when you rise too quickly, that brief disorientation as your vision blurs and steadies. For most, it’s an occasional nuisance; for those with POTS, it’s a daily struggle.
Postural Orthostatic Tachycardia Syndrome (POTS) is a complex, often debilitating disorder. The syndrome affects the autonomic nervous system, which regulates involuntary functions like heartbeat and blood pressure. When someone with POTS stands, their heart races—often surging more than 30 beats per minute—while their blood pressure dips, triggering a cascade of symptoms from exhaustion to fainting spells.
POTS affects up to 3 million Americans, the majority of whom are women or those assigned female at birth. Understanding POTS means grasping not only the science behind it but also the lived reality of those navigating its challenges daily.
What Is POTS?
POTS is more than just an accelerated heartbeat. It’s a condition where, upon standing, the nervous system struggles to maintain balance, causing blood to pool in the lower body and depriving the brain of oxygen. This leads to symptoms ranging from extreme fatigue to severe brain fog, nausea, and an unrelenting sense of lightheadedness.
Risk Factors: What Makes POTS More Likely?
The origins of POTS remain mysterious. However, certain factors appear to increase its likelihood. It disproportionately affects women, and common risk factors include:
- A family history of POTS or related autonomic disorders
- Physical trauma or major surgeries
- Viral infections (including recent links to long COVID)
- Autoimmune conditions like lupus or celiac disease
- Pregnancy
Recent studies indicate that over 1 in 10 people with long COVID develop POTS-like symptoms, and about 60% may experience symptoms resembling POTS within eight months of a COVID infection.
Symptoms of POTS: A Spectrum of Challenges
POTS symptoms vary widely in severity and frequency. Key symptoms include:
- Extreme fatigue: A debilitating tiredness that can make even simple tasks exhausting.
- Tachycardia (rapid heart rate): Especially upon standing, causing palpitations.
- Brain fog: Trouble concentrating, with memory lapses and cognitive “cloudiness.”
- Physical manifestations: Nausea, headache, excessive sweating, shaking, and intolerance to exercise.
- Circulatory symptoms: Pale complexion, purplish hands or feet when below heart level.
Certain triggers—such as heat, prolonged standing, dehydration, or insufficient salt—can exacerbate symptoms. Some women notice heightened symptoms before menstruation.
Types of POTS: Subtypes with Unique Features
POTS is not one-size-fits-all. Its three primary subtypes each impact the body differently:
- Neuropathic POTS: Nerve issues in the abdomen and legs hinder blood flow, causing swelling, discoloration, and, often, digestive distress.
- Hyperadrenergic POTS: Standing increases norepinephrine and blood pressure, resulting in heightened anxiety, breathlessness, and dizziness.
- Hypovolemic POTS: Low blood volume and red blood cell count cause muscle weakness, fatigue, and exercise intolerance.
- Diagnosing POTS: A Journey Toward Clarity
Given its range of symptoms, POTS is challenging to diagnose, often leading to a delay in care, particularly for women. Many patients wait years—women, on average, five years compared to men’s three—for an accurate diagnosis. Two common diagnostic tests include:
- 10-minute standing test: Measures heart rate and blood pressure as you stand for 10 minutes.
- Head-up tilt table test: A more formal evaluation where you’re strapped to a table that moves from a flat to an upright position to monitor cardiovascular responses.
Further tests may evaluate nervous system function, examining heart and sweating control mechanisms.
Managing POTS: A Symptom-Relief Strategy
With no definitive cure, POTS management focuses on alleviating symptoms. Treatments are tailored to individual needs and might include:
- Dietary adjustments: Increasing salt intake, staying hydrated with 64–80 ounces of water daily.
- Compression garments: Socks or stockings that push blood flow from the legs to the core.
- Medication: Beta blockers and other drugs to control heart rate and blood pressure.
- Lifestyle adaptations: Exercise, particularly isometric exercises, or physical therapy for those unable to tolerate conventional workouts.
Tools and Technology: Tracking POTS at Home
Home monitoring devices can help track symptom triggers and treatment responses:
Blood pressure monitors, heart rate monitors, pulse oximeters, and wearable tech (e.g., smartwatches or rings) provide invaluable feedback to inform lifestyle adjustments.
Self-Care and Community Support
Managing POTS requires more than physical care; emotional well-being is essential. Consider these self-care practices:
- Prioritize restful sleep to combat fatigue.
- Practice breathing exercises, yoga, or meditation to manage stress.
- Join a support group for POTS patients—having a community can make the journey less isolating.
POTS is a uniquely personal condition with symptoms and severity varying from person to person. If you or someone you know experiences persistent dizziness, rapid heart rate, or other concerning symptoms, consult a healthcare provider. The right diagnosis and a targeted care plan can make a difference in quality of life, helping those with POTS lead fuller, healthier lives.