What is POTS?

POTS stands for Postural Orthostatic Tachycardia Syndrome. It’s a disorder of the autonomic nervous system that affects blood flow to the brain. This branch of the nervous system regulates vital bodily functions such as heart rate, blood pressure, temperature regulation and digestion. 

The most common POTS symptoms are lightheadedness, dizziness, heart palpitations, chest pain, chronic fatigue, nausea, migraines, brain fog, gastrointestinal issues, shortness of breath, blood pooling, and tingling in the extremities.

While the majority of people with POTS look healthy, researchers compare the quality of life in many POTS patients to those with conditions such as chronic obstructive pulmonary disease, congestive heart failure and kidney failure.

No, POTS is estimated to impact one to three million Americans, most of whom are women of childbearing age.

According to Dysautonomia International, it takes on average five years and 11 months for patients to receive a proper diagnosis. To further complicate things, there’s also a lack of autonomic specialists in the country. Nearly 50% of people have to travel more than 100 miles from home to receive POTS-related medical care.

While POTS can develop suddenly on its own, after pregnancy or a severe injury, more often than not it develops after a viral illness or infection. Unfortunately, many COVID long-haulers are now being diagnosed with POTS.

Most doctors aren't well-versed in diagnosing POTS, so it's recommended to see a doctor that specializes in autonomic disorders. Typically autonomic specialists are cardiologists, neurologists, and electrophysiologists. Here is more information on finding a doctor. 

According to Dysautonomia International, the current diagnostic criteria for POTS is a heart rate increase of 30 beats per minute (bpm) or more, or over 120 bpm, within the first 10 minutes of standing, in the absence of orthostatic hypotension. In children and adolescents, a standard of 40+ bpm has recently been adopted. 

POTS is often diagnosed by a Tilt Table Test, or with bedside measurements of heart rate and blood pressure taken in the supine and standing-up positions at two, five, and ten-minute intervals. Doctors may perform more detailed tests to evaluate the autonomic nervous system such as a Quantitative Sudomotor Axon Reflex Test, a Thermoregulatory Sweat Test, skin biopsies looking at the small fiber nerves, and gastric motility studies. I have a page detailing my diagnosis at the Mayo Clinic here.