Postural Tachycardia Syndrome (PoTS)

Postural Tachycardia Syndrome (PoTS)

What is PoTS?

Postural Tachycardia Syndrome (PoTS) is a condition that affects the autonomic
nervous system, which controls bodily functions that we do not consciously think about
(e.g., heart rate and blood pressure). In PoTS, there is an abnormally fast heart rate
when moving from a lying or sitting position to standing. This can cause various
symptoms like dizziness, fainting, palpitation, and fatigue. Not everyone with PoTS will
experience all of these, and the symptoms can vary in severity.

PoTS is more commonly seen in young adults, especially women, and can develop after
a viral illness, trauma, or surgery. Some people with conditions like Ehlers-Danlos
Syndrome or Chronic Fatigue Syndrome may also be more prone to developing PoTS.

For more information, you can watch an excellent introductory video on PoTS
here: YouTube: PoTS Syndrome Explained.

Symptoms of PoTS

• Rapid increase in heart rate, especially on standing:
• Dizziness and lightheadedness: You may feel like you’re going to faint, especially when you stand up quickly.
• Palpitation: Feeling your heart pounding or racing.
• Fatigue: Persistent tiredness and low energy.
• Fainting (syncope): Some patients may experience full fainting episodes.
• Exercise intolerance: Difficulty performing physical activities.
• Other symptoms: Nausea, brain fog (difficulty concentrating), headaches, and sweating.

The symptoms above are not an exhaustive list and patients report many different
combinations in varying severity. For more details on the symptoms and causes of
PoTS, visit the NHS PoTS page.

Diagnosis

PoTS is typically diagnosed based on your symptoms and clinical examination, including
standing you up in clinic for 10 minutes to assess your heart rate and blood pressure
response to change in posture. PoTS
In most cases, no further tests are required to diagnose PoTS. In some cases, a tilt test
(where your heart rate and blood pressure are monitored as you move from lying down

to a standing position can be helpful. Heart rate monitors are rarely necessary. Routine
bloods tests can be useful to rule out other conditions

Management of PoTS

Most patients with PoTS do not need any specific treatment: the majority of patients can
control their symptoms well with simple modifications to their lifestyle. It is worth
persisting with these general recommendations as medications for PoTS are not usually
very effective, and frequently carry unpleasant side effects.

Lifestyle Modifications

• Increase fluid and salt intake: Drink 2-3 litres of water daily, and increase your
• salt intake (6-10 grams per day, as recommended by your doctor) to help increase blood volume and reduce symptoms.
• Compression garments: Wearing compression stockings or an abdominal binder can help reduce dizziness by preventing blood pooling in the legs.
• Exercise: Gradual, regular exercise can help strengthen the cardiovascular system. Start with recumbent activities like cycling or rowing and slowly transition to more upright exercises
• Avoid prolonged standing: Minimize standing for long periods, and when standing, move your legs frequently to improve circulation.
• Elevate the head of your bed: Sleeping with the head of your bed raised can help reduce morning symptoms by maintaining blood pressure and blood volume.
• Stop smoking

Dietary Adjustments

• Smaller, frequent meals: Large meals can make symptoms worse. Smaller meals spread throughout the day can help regulate blood flow.
• Limit caffeine and alcohol: Both can make symptoms worse by affecting heart rate and blood pressure

Coping Strategies and Symptom Management

• Postural changes: When transitioning from sitting or lying to standing, do so slowly to allow your body to adjust.
• Cooling measures: Avoid overheating. Stay cool by using fans, wearing light clothing, or applying cooling packs.
• Isometric Exercises: static exercise (like rocking on tiptoes or clenching muscles) before and after standing to improve venous return.

For more detailed guidance, refer to NHS PoTS page

Mental Health and Emotional Support

Living with a chronic condition like PoTS can be emotionally challenging. Managing
stress is important as stress can worsen symptoms. Techniques such as mindfulness,
meditation, and breathing exercises can be helpful.

Medications

Occasionally, medications can be used to help control some of the symptoms of PoTS.
Generally, medications will only help with the palpitation and light headedness, but will
not help with symptom such as fatigue. Options include beta-blockers or Ivabradine
(medications that slows the heart), or a medicine called Midodrine which can raise blood
pressure

Always discuss your medication options with your GP or specialist.

UK-Based Support Groups:

 PoTS UK: Provides comprehensive resources, support, and links to specialist
clinics across the UK. They also have patient stories and practical advice for
managing life with PoTS.

Further Information and Resources

For more detailed information and support, you can visit:
 NHS: Postural Tachycardia Syndrome (POTS): Offers clear and detailed
guidance on PoTS, its causes, symptoms, and treatments.

 Dysautonomia International: A global resource offering educational materials
and the latest research on autonomic disorders like PoTS.

 PoTS UK: A UK charity dedicated to supporting patients with PoTS through
education, advocacy, and research.

This leaflet is intended to provide general guidance. Please consult your healthcare
provider for specific advice tailored to your situation.

If your symptoms or condition worsens, or if you are concerned about anything,
please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you
and your loved ones. If you have any questions or concerns, please do speak with a
member of staff on the ward or in the relevant department who will do their best to
answer your questions and reassure you.

Feedback

Feedback is really important and useful to us – it can tell us where we are working well
and where improvements can be made. There are lots of ways you can share your
experience with us including completing our Friends and Family Test – cards are
available and can be posted on all wards, departments and clinics at our hospitals. We
value your comments and feedback and thank you for taking the time to share this with
us.

Patient Advice and Liaison Service (PALS)

If you have any concerns or questions about your care, we advise you to talk with the
nurse in charge or the department manager in the first instance as they are best placed
to answer any questions or resolve concerns quickly. If the relevant member of staff is
unable to help resolve your concern, you can contact the PALS Team. We offer informal
help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf,
if you feel unable to do so, to resolve your problems and where appropriate refer to
outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate
your concerns. You can make a complaint orally, electronically or in writing and we can
advise and guide you through the complaints procedure.

How to contact PALS:

Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:

The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please
be aware that you may need to leave a voicemail message, but we aim to return your
call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.

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