Orthostatic Tachycardia Syndrome: Symptoms & Care

Your body runs on an internal autopilot, a system that manages your heart rate, blood pressure, and digestion without you ever thinking about it. But what happens when that system gets its signals crossed? The result is chaos. Simple actions like standing up can trigger a racing heart, dizziness, and overwhelming fatigue. This is the reality of dysautonomia, and one of its most common forms is Postural Orthostatic Tachycardia Syndrome (POTS). It’s not a problem with your heart itself, but with the nervous system that controls it. Understanding this distinction is key to finding effective solutions that address the source of the miscommunication, not just the resulting symptoms.

What is Postural Orthostatic Tachycardia Syndrome (POTS)?

Have you ever felt dizzy or lightheaded every time you stand up? Does your heart race for no apparent reason? If these symptoms sound familiar, then today's discussion on POTS, or Postural Orthostatic Tachycardia Syndrome, is for you. This condition is a form of dysautonomia that affects your autonomic nervous system, which controls automatic body functions like heart rate and blood pressure.

Common Symptoms of POTS

Living with POTS means dealing with a wide range of symptoms that can appear suddenly and change from day to day. Because it’s a form of dysautonomia, the condition disrupts the autonomic nervous system—the system that’s supposed to handle all the background tasks you don’t think about, like heart rate and blood pressure. When this system is out of sync, it can feel like your own body is working against you. The symptoms can be both physical and cognitive, often making it difficult to perform even simple daily activities. Many people with POTS find their symptoms are dismissed or misdiagnosed, which is why understanding the common signs is the first step toward finding answers and effective care for the conditions that affect your life.

Cognitive and Physical Symptoms

The list of potential POTS symptoms is long and can feel overwhelming. Common experiences include extreme fatigue, lightheadedness (especially when standing), heart palpitations, and a general intolerance to exercise. You might also deal with persistent headaches, nausea, shakiness, and even fainting. Beyond these, many people report feeling cold or having pain in their hands and feet, along with chest pain and shortness of breath. These symptoms aren't just minor inconveniences; they can significantly impact your quality of life, making it challenging to work, socialize, or simply get through the day. Because these signs overlap with so many other conditions, getting a clear picture of what’s happening requires a thorough approach that looks at the entire body system, especially the nervous system's role in coordinating everything.

Brain Fog and Fatigue

Two of the most disruptive symptoms of POTS are brain fog and fatigue. Brain fog isn't just forgetfulness; it's a frustrating mental cloudiness that makes it hard to think clearly, focus on tasks, or follow conversations. As noted by Dysautonomia International, it's one of the most challenging aspects of the condition. The fatigue is also more than typical tiredness—it's a profound, bone-deep exhaustion that isn't relieved by sleep. This combination can make you feel disconnected from your own mind and body, creating significant hurdles at school, work, and in your personal relationships. It underscores how deeply a dysregulated nervous system can impact your energy and mental clarity.

Headaches, Chest Pain, and Shortness of Breath

Experiencing chest pain, shortness of breath, or severe headaches can be frightening, and for those with POTS, these are often regular occurrences. The headaches can range from dull aches to debilitating migraines. Chest pain and a racing heart can mimic symptoms of a heart attack, leading to anxiety and emergency room visits, only to be told everything looks "normal" on standard tests. These symptoms often worsen in specific situations, such as after standing for a long time, being in the heat, or even after eating a large meal. Understanding these patterns is crucial, as it can help connect these alarming symptoms to a potential issue with your autonomic nervous system's ability to regulate blood flow and heart rate properly.

Visible Physical Signs

While many POTS symptoms are invisible, some people experience physical signs that others can see. One of the most distinct is the development of a reddish-purple color in the legs when standing. This discoloration, known as livedo reticularis, happens because of blood pooling in the lower extremities. When the autonomic nervous system fails to properly constrict the blood vessels in the legs upon standing, gravity causes blood to collect, leading to poor circulation and the visible change in skin color. While it’s typically not painful, it can be a clear and often distressing indicator that your body is struggling to adapt to changes in posture, providing a visible clue to the underlying circulatory issues at play in POTS.

Common Symptom Triggers

POTS symptoms rarely exist in a vacuum; they are often made worse by specific triggers. Learning to identify these can be a powerful tool in managing your condition. Many people find their symptoms flare up in warm environments, like a hot day or even a steamy shower. Standing or sitting still for extended periods is another classic trigger. According to the Cleveland Clinic, other common culprits include strenuous exercise, dehydration, illness, and for women, the menstrual cycle. By paying attention to when your symptoms intensify, you can start to see patterns and make adjustments to your daily routine. This knowledge is a critical piece of the puzzle when seeking a comprehensive evaluation to understand the root cause of your health challenges. If you're ready to investigate further, the first step is often a detailed assessment with a specialist who understands the complexities of the nervous system. You can learn more about what to expect during your first visit with us on our website.

What People Get Wrong About POTS

POTS is often misunderstood and frequently misdiagnosed as anxiety or low blood sugar. Many patients find themselves visiting a range of specialists, from cardiologists to neurologists, without finding relief or answers. However, the hallmark indicator of POTS is a significant increase in heart rate upon standing, without a corresponding drop in blood pressure.

Diagnosing POTS: The Process and Challenges

The Key Diagnostic Criteria

Getting a formal POTS diagnosis hinges on a very specific physical response. To be diagnosed, an adult’s heart rate needs to increase by at least 30 beats per minute (bpm), or exceed 120 bpm, within the first 10 minutes of standing up. What makes this distinct from other conditions is that this heart rate spike happens without a significant drop in blood pressure. This key detail helps doctors differentiate POTS from other forms of orthostatic intolerance. It’s not just about feeling dizzy; it’s about a measurable, rapid heart rate change tied directly to your posture, which points to a dysfunction in the autonomic nervous system’s ability to adapt to gravity.

Common Diagnostic Tests

To confirm POTS, doctors use specific tests to monitor your heart rate and blood pressure as you change positions. These tests are designed to safely replicate the symptoms you experience daily, but in a controlled environment where your vital signs can be accurately measured. The goal is to capture the exact data needed to meet the diagnostic criteria. While the Tilt Table Test is considered the gold standard, a simpler Active Stand Test can also be effective. Both methods provide the crucial information a specialist needs to understand how your body is responding to the simple act of standing up.

The Tilt Table Test

The most common diagnostic tool for POTS is the Tilt Table Test. During this test, you lie flat on a special table that is then slowly tilted upright to simulate standing. All the while, your heart rate and blood pressure are continuously monitored. This controlled movement allows doctors to see precisely how your cardiovascular system reacts when you shift from lying down to a standing position. It’s a safe and effective way to measure the changes that trigger your symptoms, providing clear evidence for a diagnosis without requiring you to stand and risk fainting.

The Active Stand Test

If a tilt table isn't available, your doctor might perform an Active Stand Test right in the office. It’s a simpler but still effective way to diagnose POTS. For this test, your heart rate and blood pressure are measured while you’re lying down and resting. Then, you’ll stand up, and your vitals will be checked again at 2, 5, and 10-minute intervals. This test helps document the sustained heart rate increase that occurs upon standing, which is the classic sign of POTS, providing the necessary data for a diagnosis.

Why Getting a Diagnosis Can Be Difficult

If you’ve been struggling to get answers, you’re not alone. The journey to a POTS diagnosis can be long and frustrating, with many people seeing multiple doctors over several years. Because the symptoms are so varied—ranging from fatigue and brain fog to heart palpitations and nausea—they are often mistaken for anxiety or other conditions. This complexity means that unless a doctor is specifically looking for POTS and performs the right tests, the underlying issue can be missed. Understanding that your wide-ranging symptoms are connected is the first step toward finding a practitioner who can finally provide clarity.

Understanding the Causes and Types of POTS

Neuropathic, Hyperadrenergic, and Hypovolemic POTS

It’s helpful to think of POTS not as a single disease, but as a collection of symptoms that point to an underlying issue with the autonomic nervous system. Researchers have identified several subtypes, each with a different root cause. Neuropathic POTS is linked to damage to the small-fiber nerves that help regulate blood vessel constriction. Hyperadrenergic POTS involves elevated levels of the stress hormone norepinephrine, leading to an overactive sympathetic nervous system. Finally, Hypovolemic POTS is associated with abnormally low blood volume. Identifying the type of POTS you have can help guide a more effective and targeted approach to managing the conditions that affect your health, which is central to finding lasting wellness.

Who Gets POTS?

While POTS can affect anyone, we often see it in young women aged 15 to 35. It can be triggered by factors such as viral infections, concussions, pregnancy, or trauma. It’s important to note that trauma can also be emotional, not just physical.

How to Manage POTS Symptoms

In cases of POTS, a multi-disciplinary approach is crucial. At our clinic, we specialize in addressing the underlying issues using Quantum Spinal Mechanics or QSM3. This method helps correct upper cervical misalignments that can affect the nervous system, including the vagus nerve. Such precision care has enabled many of our patients to resume normal activities, including playing sports and attending school.

Diet and Hydration Strategies

Managing POTS often starts with simple, consistent daily habits, especially when it comes to what you eat and drink. For many people with this condition, particularly those with low blood volume, increasing fluid and salt intake is a game-changer. Aim for about 2 to 2.5 liters of water per day to stay well-hydrated. At the same time, incorporating more salt—anywhere from 3,000 to 10,000 mg daily, as recommended by your doctor—can help your body retain that fluid and maintain blood pressure. Instead of just reaching for the salt shaker, you can add healthy, salty foods to your diet. Think about sipping on broth, snacking on pickles and olives, or grabbing a handful of salted nuts. These small adjustments can make a significant difference in managing your daily symptoms.

Exercise and Movement

When you're dealing with POTS, the idea of exercise can feel daunting, but the right kind of movement is incredibly beneficial. The key is to start slow and choose activities that don't require you to be upright for long periods. Reclined aerobic exercises are often the best place to begin; think swimming, rowing, or using a recumbent bike. These activities get your heart rate up without triggering your symptoms. It's also helpful to focus on strengthening your core and leg muscles, as strong muscles help pump blood back up to your heart. You can even do isometric exercises—like squeezing your leg or glute muscles without moving—before you stand up to give your circulation a little assistance and prevent dizziness.

Helpful Tools and Lifestyle Adjustments

Beyond diet and exercise, a few practical tools and lifestyle changes can help you manage POTS more effectively. Medical compression stockings are a great tool for preventing blood from pooling in your legs, which is a common issue with this condition. You can also try raising the head of your bed by about 6 to 10 inches; this simple trick can help reduce those intense morning symptoms. Since heat can make POTS symptoms worse, it's wise to avoid hot baths, saunas, and being out on very hot days. When you can't avoid the heat, having fans, air conditioning, or even a personal cooling vest on hand can provide much-needed relief and help you feel more in control.

First Aid for Faintness

One of the most unsettling symptoms of POTS is feeling faint or lightheaded. Knowing what to do in that moment can help you feel safer and more prepared. If you feel faintness coming on, the best thing to do is lie down immediately and elevate your legs above your heart. Stay in that position until the feeling passes. If you're in a situation where you can't lie down, there are still things you can do. Try crossing your legs while standing, rocking back and forth on your toes, or tightly clenching the muscles in your fists, abdomen, and buttocks. These actions, called counter-maneuvers, help push blood back up toward your brain and can often stop a fainting spell in its tracks.

Conventional Medical Treatments

While lifestyle strategies are the foundation of POTS management, sometimes they aren't enough on their own. Currently, there are no medications specifically approved by the FDA to treat POTS. However, doctors can prescribe certain medications "off-label" to help manage specific symptoms. For example, a medication called Fludrocortisone can help your body retain salt and water, which increases blood volume. Others, like Midodrine, work by tightening blood vessels to prevent blood from pooling in your lower body. Beta-blockers are sometimes used to help control a rapid heart rate. Finding the right medication can involve some trial and error, so it's important to work closely with a physician who understands the complexities of autonomic disorders.

Addressing the Root Cause with Upper Cervical Care

Managing symptoms is crucial, but at Lazar Spinal Care, we believe in looking deeper to address the root cause. POTS is fundamentally a disorder of the autonomic nervous system, which regulates all of your body's automatic functions. This system's control center is located in the brainstem, which is protected by the top two bones in your neck—the upper cervical spine. A misalignment in this critical area can interfere with the communication between your brain and body, contributing to the dysfunction seen in POTS. Our specialized QSM3 technique allows us to gently and precisely correct this misalignment, restoring proper nervous system function. By focusing on the source of the problem, we help your body heal itself so you can get back to living your life fully.

The Impact of POTS on Daily Life

Living with POTS is far more than just feeling dizzy when you stand up; it's a constant negotiation with your own body. For some, the symptoms are a manageable nuisance, but for many others, they are completely debilitating. Imagine mustering the energy for a simple shower feeling like you're about to run a marathon, or finding that basic chores like cooking a meal or doing laundry are monumental tasks. The condition can severely limit a person's ability to participate in work, school, and social activities, turning everyday life into a series of challenges. This isn't just about feeling unwell; it's about your entire world shrinking as you try to manage unpredictable and overwhelming symptoms that others can't see.

To put its severity into perspective, medical professionals have compared the daily struggles of POTS patients to those living with conditions like COPD or heart failure. The impact on a person's well-being is profound. According to research on dysautonomia, approximately 25% of people with POTS are so disabled they are unable to work, and their overall quality of life is often compared to that of patients on dialysis for kidney failure. The unpredictability is also a major factor, as symptoms like brain fog, fatigue, and a racing heart can flare up from triggers like heat, a large meal, or simply standing for too long, making it incredibly difficult to plan your life.

Living Well with POTS: Real Stories

Let’s share some successes. There was a young girl who struggled with blackouts and migraines. Through our treatment, she managed to overcome these debilitating symptoms entirely. Similarly, a nurse on the verge of giving up her career due to fainting spells has now returned to active duty, thanks to the interventions we offer.

Understanding POTS and Related Conditions

Understanding POTS extends beyond individual symptoms to recognizing it within a broader medical context. Many with POTS also deal with conditions like migraines, irritable bowel syndrome, and connective tissue disorders such as Ehlers-Danlos syndrome. Interestingly, post-COVID statistics show a significant rise in POTS cases, with an estimated 20 million people worldwide affected.

Prognosis and Recovery Statistics

If you've recently been diagnosed with POTS, you might be worried about what the future holds. The good news is that POTS is not considered life-threatening, and most people have a normal life expectancy. Research shows that the outlook is generally positive, with about 80% of people seeing their condition improve with the right care. However, it's also true that living with POTS can be incredibly challenging, and approximately 25% of patients are so affected they are unable to work. Some studies have even found that the impact on a person's quality of life is comparable to that of someone on dialysis. This highlights how crucial it is to find an approach that doesn't just manage symptoms but addresses the root cause, which is why we focus on uncovering the source of the problem for the conditions we help.

Raising Your Voice for POTS Awareness

As awareness grows, notable institutions like NIH and Johns Hopkins are spotlighting POTS. Media coverage has increased, shedding light on POTS as a long COVID complication. This advocacy is crucial for early detection and treatment.

How You Can Support the POTS Community

For those experiencing or witnessing symptoms like frequent fainting or a racing heart upon standing, early intervention is essential. We encourage people to seek a proper workup, including tests like tilt table assessments, and explore comprehensive treatment plans that might involve hydration strategies, dietary adjustments, and rehabilitation exercises.

Looking Forward: Hope and Healing

Our message is one of hope. POTS is a real, manageable condition with a promising pathway to recovery. By addressing the root causes and utilizing team-based and innovative care approaches, individuals can reclaim their lives. Awareness and early recognition are key, so don't hesitate to reach out for help if needed.

We hope you find this information helpful and share it with those who might benefit. Until next time, stay well and take care!

Frequently Asked Questions

My heart races when I stand up. Does that automatically mean I have POTS? While a racing heart upon standing is a classic sign of POTS, it isn't an automatic diagnosis. The key is a specific, sustained increase in heart rate—at least 30 beats per minute for adults—that happens within 10 minutes of standing, all without a major drop in blood pressure. Many things can cause a temporary heart rate spike, so getting a proper evaluation with specific tests, like an Active Stand Test, is the only way to know for sure.

Is POTS a heart condition? This is a common and important question. POTS is not a problem with the structure of your heart itself. Instead, it's a disorder of the autonomic nervous system, which is the system that controls all your body's automatic functions, including heart rate and blood pressure. Think of it as a communication issue; your brain isn't sending the right signals to your blood vessels and heart when you change posture, leading to the symptoms you feel.

Why would an upper cervical chiropractor be able to help with POTS? It's a fair question, as most people don't immediately connect chiropractic care with a condition like POTS. The control center for your autonomic nervous system is located in your brainstem, which is protected by the top two bones of your neck. If these bones are misaligned, they can interfere with the critical communication between your brain and the rest of your body. Our focus is on gently correcting this specific area to restore proper nervous system function, which can address the root cause of the miscommunication seen in POTS.

What's the first step I should take if I think I have POTS? If the symptoms described in this post sound familiar, a great first step is to start tracking them. Note when you feel dizzy, fatigued, or when your heart races, and what you were doing right before it happened. This information is incredibly valuable. The next step is to schedule an evaluation with a healthcare provider who understands autonomic disorders. A thorough assessment is needed to rule out other conditions and get you on the right path to feeling better.

Can POTS be cured, or is it a lifelong condition? The outlook for people with POTS is generally very positive. While there isn't a single "cure," many people find that their symptoms improve significantly with the right combination of lifestyle strategies and care that addresses the underlying cause. Some people even experience a full recovery. The goal is to manage the condition effectively so you can get back to your daily activities without being held back by your symptoms.

Key Takeaways

• Understand the source of your symptoms: POTS isn't a heart condition; it's a communication breakdown in your autonomic nervous system. This system is your body's autopilot, and when its signals get crossed, you experience symptoms like a racing heart and dizziness upon standing.
• Take control with practical daily habits: Simple adjustments can make a huge difference in managing POTS. Focus on increasing your fluid and salt intake to support blood volume, try reclined exercises like swimming or rowing to build strength without triggering symptoms, and use compression stockings to improve circulation.
• Look to your upper spine for a potential root cause: Your autonomic nervous system's control center is in your brainstem, protected by the top bones of your neck. A misalignment here can disrupt communication between your brain and body, contributing to POTS. Correcting this structural issue can help restore proper function and address the problem at its source.

Related Articles

• Understanding POTS: A Deep Dive into Postural Orthostatic Tachycardia Syndrome
• Dysautonomia Bloating: Why It Happens & What to Do
• Your Guide to Chiropractic for Dysautonomia in Ann Arbor