When a healthy person stands up, the heart quickens for a beat or two and then settles. In postural orthostatic tachycardia syndrome (POTS), the rate keeps climbing. According to the US National Institute of Neurological Disorders and Stroke, the heart rate rises by more than 30 beats per minute, or above 120 beats per minute, within 10 minutes of standing up.
That is a measurable physical event in the autonomic nervous system, not a nervous reaction. But because the sensations feel like a panic attack, POTS is one of the most misidentified conditions in medicine.
An estimated 1 to 3 million Americans had POTS before the pandemic, and long COVID has pushed the number higher, with studies suggesting that anywhere from 2 to 14 percent of people who catch COVID-19 later develop it.
Most patients are women of childbearing age. The average person waits five years and eleven months for a diagnosis, and roughly 69 percent are first told they have an anxiety disorder.
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8 warning signs to know
The percentages below come from a community survey of POTS patients cited in a 2021 NIH-indexed review of POTS management.
1. Lightheadedness on standing. Reported by 99 percent of patients. It typically eases within seconds of lying back down.
2. A racing heart when you stand up. Tachycardia is reported by 97 percent. This is the cardinal, measurable sign, a jump of more than 30 beats per minute within 10 minutes of getting up.
3. Near-fainting (presyncope). Reported by 94 percent. The pre-collapse feeling of graying vision, ringing ears and cold sweat.
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4. Shortness of breath on standing. Reported by 88 percent, often within a minute of getting upright.
5. Heart palpitations. Reported by 87 percent. A pounding or fluttering awareness of the heartbeat, not always identical to the measured tachycardia.
6. Brain fog. Difficulty concentrating, word-finding trouble and mental slowness, all typically worse when upright and better lying down.
7. Exercise intolerance. Even mild activity can trigger a symptom flare, and recovery takes much longer than expected.
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8. Headache and chronic fatigue. Often day-long, and often worse in the morning after time spent upright.
How to tell POTS apart from anxiety
Anxiety can drive the heart rate up, but it does not produce a consistent 30-beat rise that appears every time you stand and eases every time you lie down. POTS symptoms follow posture. Anxiety symptoms follow thoughts and situations.
The Cleveland Clinic also lists several common triggers for POTS, including viral illness (COVID-19 among them), pregnancy, major surgery and physical trauma. Symptoms often begin weeks after one of those events.
What to ask your doctor
If your heart races and your head swims almost every time you stand, ask your doctor about a tilt-table test or a 10-minute standing heart rate measurement. The tilt-table test is the standard tool cardiology and autonomic clinics use to confirm POTS, tracking heart rate and blood pressure as your position changes.
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This article is made and published by Jesper Bengtson, who may have used AI in the preparation.