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On standing the heart races without the blood pressure holding — real, measurable and trainable.
Also known as: postural orthostatic tachycardia syndrome · orthostatic intolerance · POTS
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
A disorder of the autonomic nervous system: on standing, the pulse rises sharply (in adults by at least 30 beats/min) without a marked drop in blood pressure. This causes palpitations, dizziness, light-headedness, exhaustion and brain fog that ease when lying down. POTS is real and often very limiting, frequently affects younger women and sometimes begins after an infection. It is often mistaken for anxiety — but it is not. With the right measures, much can be improved.
Enough fluid and, if advised, more salt raise blood volume and ease symptoms.
Compression on legs/abdomen reduces blood pooling when upright.
Building up lying/seated (e.g. rowing, recumbent cycling), increased slowly — not forced against the body.
Rule out other causes; if needed, medicines can stabilise circulation.
No drug is licensed for POTS; what is used (beta blockers, ivabradine, midodrine, fludrocortisone) damps the heart rate or holds volume in the circulation. What moved most in studies is unspectacular: two to three litres of fluid and six to ten grams of salt a day, compression, and training that starts lying or seated — built up over three months, because upright training too early makes symptoms worse.
The diagnosis rests on a rise in heart rate of at least thirty beats (forty in adolescents) within ten minutes of standing — without the blood pressure falling. Symptoms must have lasted at least three months. Those affected are mainly young women. A training build-up that starts lying down shows measurable improvement over three months; in some the situation improves considerably over years.
The pulse rises markedly when upright, often pounding up to the neck.
Up to near-fainting; improves when lying down.
Persistent tiredness and concentration trouble, often all day.
Anaemia produces the same picture: a racing heart on standing, weakness, light-headedness. Ruling it out comes first.
An iron shortage without anaemia strengthens the racing heart and the exhaustion. It is often overlooked because the blood count looks normal.
An overactive thyroid causes a racing heart and restlessness and is readily treatable. It is among the few values that supply a different explanation.
Important, because more salt and more fluid are among the basic measures. The starting value belongs known beforehand.
Makes sure the muscle lets go again after tensing. A lack favours cramps, twitching and inner restlessness — and the blood value reflects the store poorly.
Sets the excitability of muscle and nerve. A low value causes weakness and cramps, a high one is dangerous for the heart rhythm — here one measures rather than guesses.
Sets off the tensing in the muscle in the first place. A low value causes tingling around the mouth and in the fingers and cramping of the hands.
With heavy sweating both are lost together. Drinking only water dilutes the sodium further — with long exertion salt belongs with it.
The basic measure in POTS: 8–10 g of salt a day and 2–3 litres of fluid. That is an unusually high amount and belongs medically accompanied — with high blood pressure or heart failure it does not apply.
Low ferritin worsens racing heart and exhaustion on standing. It is among the first values and is replaced after measuring, not preventively.
A deficiency also disturbs the regulation of the circulation on standing. Measured before replacing — afterwards the value says nothing.
Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.
On standing up blood sinks into the legs; the body answers with a surge of this hormone. In one form of POTS this answer is far too strong — hence the racing heart, trembling and inner restlessness when upright.
This axis determines how much salt and water stay in the circulation. It is the reason more salt and two to three litres of drinking are among the most effective measures.
Holds water back in the body. Together with the axis above it explains why drinking spread across the day does more than a large amount at once.
Belongs to the control of the circulation and to the distinction: an underactive adrenal gland makes a very similar picture of weakness, dizziness and craving for salt, and is treatable.
Studied at 2–3 litres of fluid and 8–10 g of salt a day, spread out. Half a litre of water drunk quickly raises blood pressure for about 30–60 minutes — useful before standing up. This does not apply with high blood pressure or kidney disease.
After large carbohydrate-rich meals circulation dips as blood moves to the belly. 5–6 smaller meals keep it flatter.
Studied are programmes that start lying or sitting — rowing, recumbent bike, swimming — and move to upright over 3 months. Starting upright too early regularly leads to giving up.