Understanding POTS: When Standing Up Makes You Sick

Postural Orthostatic Tachycardia Syndrome — POTS — is a form of dysautonomia, a disorder of the autonomic nervous system. Its defining feature: a sustained, abnormal increase in heart rate when moving from lying down to standing, accompanied by symptoms that improve when lying back down.

What Happens in POTS

In a healthy person, standing up triggers the autonomic nervous system to constrict blood vessels and slightly increase heart rate, keeping blood flowing to the brain. In POTS, this response goes wrong. Blood pools in the lower body, the heart races to compensate, and the brain does not get the blood flow it needs.

Common Symptoms

• Rapid heartbeat upon standing (an increase of 30+ beats per minute in adults)
• Dizziness, lightheadedness, or fainting
• Brain fog and difficulty concentrating
• Profound fatigue
• Nausea and gastrointestinal issues
• Shakiness, sweating, and anxiety-like symptoms
• Exercise intolerance

Who Gets POTS?

POTS most commonly affects young women between 15 and 50. It often develops after a triggering event such as a viral illness, pregnancy, surgery, or trauma. It is also strongly associated with hypermobile Ehlers-Danlos syndrome and mast cell activation syndrome — the "trifecta" familiar to many in the rare disease community.

The Long Road to Diagnosis

POTS is frequently misdiagnosed as anxiety, depression, or chronic fatigue. Patients — often young women — are told their racing heart and dizziness are "just stress." The average diagnostic delay is several years. A tilt table test or active stand test, measuring heart rate and blood pressure changes with position, is the key diagnostic tool.

Management Strategies

There is no cure, but many patients improve significantly with:

• Increased fluid and salt intake to expand blood volume
• Compression garments to reduce blood pooling
• Recumbent exercise programs that gradually rebuild tolerance
• Medications such as beta blockers, fludrocortisone, or midodrine
• Pacing — learning to work within the body's limits

Why Awareness Matters

POTS awareness has grown in recent years, partly because post-viral POTS cases brought new attention to dysautonomia. But millions still suffer without a name for their experience. If standing up routinely makes you feel ill, consider asking your doctor about POTS — and if they dismiss you, find one who will listen.