POTS 101

POTS is defined as a rise in heart rate of greater than 30 beats per minute after 5 minutes of standing from supine. The general term for a drop in blood pressure with standing is called “orthostatic intolerance.”

  • Symptoms: dizziness when standing up, fainting, fatigue, poor concentration, difficulty with word finding, confusion

What is happening with POTS?

When an adult stands up, gravity pulls 2 quarts of blood (out of a total of 6 quarts) from the upper half of the body (including the brain) into the lower half of the body.

Normal response

  1. The brain senses a sudden loss of blood and triggers a response.

  2. The heart beats faster to move the blood toward the head/brain.

  3. The heart beats with greater force to work against gravity.

  4. The blood vessels in the lower half of the body constrict to increase force.

  5. Blood pressure temporarily increases.

  6. All of this happens within two heartbeats of standing up.

  7. Person has no awareness of the blood volume shift = no symptoms

When a person with POTS stands up…

  1. The brain senses a sudden loss of blood and triggers a response.

  2. The heart beats faster to move the blood toward the head/brain.

  3. Heart does not beat with greater force.

  4. Blood vessels do not have the resting muscle tone or proper brain signals to contract.

  5. Blood pressure typically does not accommodate increased need for blood and stays stable or drops.

  6. The brain senses a continued loss of blood so the heart continues to beat faster to try to make up for decreased relative blood pressure.

  7. If adequate blood volume/pressure to the brain is not achieved, fainting or brain fog occurs.

Symptoms

  • Heart rate increases upon standing 

  • BP tends to decrease, HR increases

  • Palpitations

  • Dizziness

  • Blood pooling in legs

  • Near fainting or fainting

  • Brain fog/difficulty concentrating

Treatment suggestions

  • Awareness of symptoms and triggers, pacing

  • Increase fluid/salt intake (6000mg sodium/day, one tsp table salt = 2300mg sodium) or salt tablets (ONLY under supervision of an MD)

  • Trial of gulping 16oz before rise in am

  • Compression garments (full length or abdominal binder, apply before rise in am)

  • Graded exercise beginning in supine and with legs

  • Change positions slowly

  • Manage body temperature

  • Consider meds: midodrine, ivabradine, fludrocortisone



[Please note: Wendy4Therapy is not a medical doctor and is not licensed to provide an official medical diagnosis. Education provided here is for your information only, and it is expected that you visit a medical practitioner who is licensed to provide a diagnosis for further exploration. Wendy4Therapy can take you through the diagnostic criteria but cannot formally diagnose EDS or related conditions. Please do  not reproduce without permission. This is GENERAL and not intended to be customized for individual patients. Please follow consultation and recommendations of your healthcare provider for specifics to your condition.