Postural tachycardia syndrome, also known as postural orthostatic tachycardia syndrome (PoTS), is a condition that causes an abnormal increase in your heart rate after sitting up or standing up. The most common symptoms are feeling lightheaded or dizzy, palpitations (being aware of your heartbeat) and fatigue.  

Normally when you sit up or stand up, gravity makes some of your blood flow downwards in your body, which can cause your blood pressure to drop. Your body responds by narrowing your blood vessels and slightly increasing your heart rate to prevent a fall in blood pressure and to maintain blood supply to the heart and brain. But if you have PoTS these automatic changes don’t happen. When you move to an upright position the supply of blood to your heart and brain drops and your heart rate increases to compensate and to try and increase the blood flow.  

PoTS is caused by a problem in the autonomic nervous system, the body’s unconscious control system in charge of important functions such as heart rate and breathing. We don’t yet understand why this part of the nervous system doesn’t work the way it should in people with PoTS.  

Some people have mild symptoms, while others find it affects their quality of life. While there is no cure for PoTS, it can often improve over time. There are lifestyle measures that can help improve symptoms, and some people may also be offered medication.

Things you can try include:

• drink plenty of fluids
• sit or stand up slowly when you’ve been lying down
• raise the head of your bed so you’re not fully horizontal at night
• avoid lots of caffeine or alcohol
• avoid long periods of standing.

A small number of people may be advised to increase the amount of salt in their diet. But it’s important to only do this if advised by your doctor as too much salt can be harmful for some people. Compression clothing, such as support can be helpful.  Keep active daily, but pace yourself and take it gently if you need to.

If you are still having symptoms despite making lifestyle adjustments your doctor may suggest trying a medication No single medication is used for the treatment of PoTS, but your doctor might suggest trying the following: can include ivabradine or a very small dose of beta-blocker to slow the heart rate, midodrine, which narrows the blood vessels, or fludrocortisone, which retains salt to increase your blood volume.

If you think you may have PoTS, make an appointment to see your GP. You may refer you to see a specialist for some tests.   

There is emerging evidence that some people who develop long Covid have similar symptoms to people with PoTS. If you have PoTS-like symptoms after having Covid-19, you should let your doctor know. They will want to assess you to ensure you are correctly diagnosed and receive treatment if necessary.

• Find out more about postural tachycardia syndrome from PoTS UK a charity for people who are affected by the condition. 

Symptoms

Some people notice that feeling hot, being dehydrated, eating, strenuous exercise can make their symptoms worse.

Some people find their symptoms are worse in the morning.

Symptoms can also vary day to day.

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