Postural Tachycardia Syndrome (POTS)

What is POTS?

POTS is a malfunction of the autonomic nervous system, which controls the body’s involuntary actions such as: heart rate, blood pressure, digestion, etc. 

POTS is a chronic condition which can vary in degrees of severity on a daily basis. Some days, a patient with severe symptoms will have to lie down for the whole day, unable to function. Many patients find themselves initially house-bound due to the symptoms. There are severe, moderate and mild cases of POTS. No two patients are the same and no two cases respond to treatment the same.

A common feature is the inability to stand up from a sitting or lying position without experiencing symptoms (orthostatic intolerance). Complaints of tachycardia, migraines, palpitations, tremor, nausea and insomnia are mentioned time and time again. Some also experience syncopal attacks. At times sufferers can be severely limited as to what they can do.

Housework, showering and even eating can exacerbate these symptoms. Many patients find menstruation and exposure to heat and humidity an aggravating factor. Some patients are so incapacitated by their symptoms that they are often misdiagnosed as having chronic anxiety or panic disorder or, worse, being told that it is all ‘in their head’.

Diagnosis and treatment of PoTS

Dr Blair Grubb, Professor of Medicine and Paediatrics, University of Toledo and leading expert on autonomic disorders, discusses the diagnosis and treatment of postural tachycardia syndrome (PoTS).

What are the symptoms of POTS?

The main symptoms of POTS can include:

  • Chronic dizziness
  • Light headedness
  • Severe unrelenting fatigue
  • Migraine
  • Insomnia
  • Palpitations
  • Blurred vision
  • Weakness

However, some patients will also complain of:

  • Anxiety
  • Loss of concentration
  • Shortness of breath
  • Coldness of legs and fingers
  • Body temperature regulation issues
  • Hyperventilation or very fast breathing that can result in loss of blood pressure and fainting

Who suffers with POTS?

Most sufferers of POTS are between 15 and 50 years of age, but it can strike at any time.

Research has shown that approximately five times more females are affected by POTS than males and, sadly, some sufferers wait a year before talking to their doctor – afraid they will won't be taken seriously. Developmental POTS affects adolescents. Often beginning around age 14, peaking at 16, then slowly fading in young adulthood. It can occur typically after the onset of puberty and sometimes following a period of rapid growth. Patients can suddenly develop symptoms following a viral infection or severe shock. Some autonomic specialists believe that there may be an overlap between people with POTS and some individuals suffering from chronic fatigue syndrome.

What help is there?

Some sufferers become debilitated and find it impossible to continue working or struggle to attend school on a regular basis. This can cause depression and it is essential that they have the support and understanding of their doctor. Cognitive Behaviour Therapy (CBT) has proved to be very successful in helping a patient come to terms with this often overwhelming condition and to help them manage their lives. Some specialists do prescribe medication. Researchers are attempting to identify and treat the causes of POTS. Studies are showing that patients will eventually suffer fewer symptoms, less frequently. It needs to be recognized that POTS can be quite disabling for the patient and very stressful for their family. There is no one treatment for everyone and sometimes it is a case of trial and error, but patients should never lose hope. Hope is a powerful medicine that should be nurtured.

For more information on POTS visit  

STARS thanks Blair Grubb, MD, Cardiology, Medical University of Ohio, for his support by providing information on POTS. We also acknowledge the work and advice of Debra Dominelli with DynaKids.

Postural Tachycardia Syndrome (POTS) - Mayo Clinic

Phil Kischer, MD discusses the latest research on POTS

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What is the Autonomic Nervous System?

The Autonomic Nervous System (ANS) controls everything we don’t have to think about. Examples of this are heart rate, blood pressure, body temperature and breathing, among other things. Normally we can adjust to changes around us very quickly. However, a person whose ANS isn’t working correctly does not respond normally. It may take them longer to adjust or they may do just the opposite of what is expected. This can also start a cycle of trying to re-adjust to a given situation – for example, the heart rate rises then drops, then rises again. A simple explanation is that the heart and the brain are divorced and are refusing to speak to each other.

For more information on the Autonomic Nervous System visit the American Heart Association,

Download POTS information sheet