What is Postural Tachycardia Syndrome (PoTS)?

PoTS, or Postural Tachycardia Syndrome, is a condition that affects how your heart rate responds when you move from sitting or lying down to standing. In very simple terms, if you have PoTS, your heart beats too fast when you stand up much faster than it should and this can cause dizziness, fainting, and a range of other unpleasant symptoms.

It’s a condition that’s often misunderstood or misdiagnosed. So, I want to explain what PoTS is, what causes it, how it’s diagnosed, and what treatments are available whether through the NHS or privately.

What Actually Happens in PoTS?

Normally, when you stand up, your body adjusts to the change in position. Blood vessels tighten slightly, your heart rate increases just a bit, and blood continues flowing to your brain.

But in people with PoTS, this automatic adjustment doesn’t work properly. When standing, your heart rate rises by more than 30 beats per minute (or over 120 bpm in total), and this happens within 10 minutes of standing. Importantly, this happens without a drop in blood pressure, which separates PoTS from other conditions like orthostatic hypotension.

What Are the Main Symptoms?

PoTS can cause a variety of symptoms, and they can vary day to day. Some of the most common include:

• Rapid heartbeat (palpitations) when standing

• Light-headedness or dizziness

• Fatigue (sometimes severe)

• Shakiness or tremors

• Nausea

• Brain fog or difficulty concentrating

• Shortness of breath

• Chest pain

• Fainting or near-fainting episodes

These symptoms often ease when you lie down, which is one of the key signs doctors look for.

What Causes PoTS?

PoTS is not caused by a single factor. It’s often considered a dysautonomia, meaning a dysfunction of the autonomic nervous system the part of the body that controls things like heart rate and blood pressure.

There are several known causes and contributing factors:

• Viral infections (PoTS can sometimes develop after a virus)

• Hormonal changes, including those related to menstruation

• Prolonged bed rest or inactivity

• Autoimmune conditions

• Hypermobile Ehlers-Danlos Syndrome (hEDS)

• Genetics (PoTS sometimes runs in families)

• It’s also been increasingly linked to Long COVID

Sometimes, no clear cause is found. But what matters is that the condition is very real and treatable.

Who Gets PoTS?

It’s estimated that PoTS affects around 1 in 100 people, but many are never formally diagnosed. It most commonly affects:

• Women aged between 15 and 50

• People with autoimmune diseases

• People with connective tissue disorders (like hEDS)

• People who’ve recently had a virus or long period of illness

Although it’s more common in younger women, anyone including men and children can develop it.

How Is PoTS Diagnosed?

The diagnosis of PoTS involves a few key steps:

1. Medical history and symptom reviewYour doctor will ask about your symptoms and how they change with position.

2. Active stand test or tilt table testThis involves monitoring your heart rate and blood pressure while lying down and then again after standing up for 10 minutes. If your heart rate increases by 30+ bpm (or reaches 120+ bpm) without a significant drop in blood pressure, it suggests PoTS.

3. Additional testsBlood tests, ECGs, echocardiograms, and other assessments may be used to rule out other causes of your symptoms.

At clinics like ours, we often use ECG monitoring as part of a broader diagnostic pathway.

Is It a Serious Condition?

PoTS isn’t life-threatening, but it can be life-altering. For some, it causes only mild symptoms, while others may struggle with daily tasks, education, or work.

The good news is that with the right diagnosis and treatment, most people see significant improvement. In some cases, PoTS can go into remission.

What Treatments Are Available?

There’s no one-size-fits-all treatment for PoTS, but it can often be managed with a combination of lifestyle changes and, when needed, medication.

Lifestyle Management

• Increase fluid intake (2–3 litres/day)

• Increase salt intake (if your doctor agrees)

• Compression stockings to improve circulation

• Physical activity (particularly recumbent or seated exercises)

• Avoiding triggers, like hot environments or long periods of standing

• Pacing learning to manage energy throughout the day

Medications

If lifestyle changes aren’t enough, medication may help, such as:

These would be prescribed based on your individual situation, and they often require regular review.

Should I Go Private or NHS?

Both NHS and private clinics in the UK can diagnose and treat PoTS. The main differences are in waiting times and access to specialist testing.

• NHS: No cost, but you may wait several months for specialist referral.

• Private clinics: Faster diagnosis and wider access to specialist cardiologists and tilt testing, but it comes at a cost likely around £250–£700 for consultation and tests.

Heartsure offer access to both general and specialist care pathways for PoTS and related conditions like arrhythmias or heart failure.

Is PoTS Linked to Mental Health?

One of the most frustrating misconceptions about PoTS is that it’s “just anxiety.” While the symptoms can feel like anxiety (rapid heart rate, light-headedness), PoTS is a physical condition. That said, living with chronic symptoms can understandably lead to anxiety or low mood over time. It’s important that patients feel believed and supported. Psychological support or talking therapies can be helpful as part of treatment, but they don’t replace medical management.

Is PoTS the Same as Long COVID?

No, but they are closely linked. A growing number of people with Long COVID are now being diagnosed with PoTS, particularly those with persistent fatigue, dizziness, or racing heart when standing. Researchers are still studying how and why this happens, but awareness is improving.

Will I Always Have PoTS?

Many people improve significantly over time, particularly with the right support. In some cases, symptoms go away entirely. Others may find it becomes a manageable part of life.

What matters most is getting the right diagnosis, building a plan that works for you, and having ongoing care that takes your symptoms seriously.

Summary

PoTS can be an overwhelming diagnosis at first, especially because the symptoms can feel vague or unpredictable. But with proper assessment, lifestyle changes, and, where needed, medication, it is possible to feel better and take control of your health. If you’ve been struggling with symptoms like dizziness, a racing heart, or fainting especially when standing it’s worth speaking to your GP or a cardiology clinic. You might find that what’s been labelled “anxiety” is actually something your body’s been trying to tell you all along.