If your heart races when you stand up, you feel dizzy in the shower, or you’re exhausted after simple tasks — and no one can tell you why — there’s a chance you’re dealing with Postural Orthostatic Tachycardia Syndrome, or POTS.
Though it affects an estimated 1 to 3 million Americans, POTS remains underdiagnosed and misunderstood, even by many healthcare providers. The symptoms are real. The condition is real. And yes — there are treatments that help.
In this guide, we’ll break down POTS in plain language: what it is, why it happens, what symptoms to look for, and how to get diagnosed and treated — especially if you’re seeking a POTS doctor in Maryland or beyond.
What Is POTS? (Simple Definition)
POTS stands for:
- Postural – related to body position
- Orthostatic – standing up
- Tachycardia – a fast heart rate
- Syndrome – a group of symptoms that occur together
In simple terms, POTS is a condition where your heart beats much faster than it should when you stand up, often accompanied by other symptoms like dizziness, fatigue, and brain fog. It’s a type of dysautonomia, which means it involves problems with your autonomic nervous system — the system that controls automatic functions like heart rate, blood pressure, digestion, and body temperature.
What Happens in the Body?
When a healthy person stands up, gravity pulls blood downward into the legs and lower body. Your body reacts by tightening blood vessels and slightly increasing your heart rate to keep blood flowing to the brain.
In people with POTS, this system doesn’t work correctly:
- Blood pools in the lower body
- The heart races to compensate
- But blood doesn’t flow back to the brain efficiently
- This causes lightheadedness, fatigue, and other symptoms
It’s like your body is overreacting to standing up — but not in a way that helps.
Common Symptoms of POTS
People with POTS experience a wide range of symptoms. You don’t have to have all of them, but some of the most common include:
Cardiovascular
- Fast heartbeat when standing (usually over 120 bpm)
- Heart palpitations
- Chest discomfort or tightness
Neurological
- Dizziness or lightheadedness (especially when standing)
- Brain fog
- Headaches or migraines
- Anxiety-like symptoms (but not always true anxiety)
Fatigue
- Extreme exhaustion after standing, walking, or light activity
- Trouble waking up or staying alert during the day
Autonomic
- Sweating too much or too little
- Temperature sensitivity
- Purple or blotchy discoloration in hands and feet
Cognitive
- Difficulty focusing, thinking, or processing information
- Memory problems
Digestive & Other
- Nausea or bloating
- Shakiness
- Sleep disturbances
Many people describe POTS symptoms as feeling like they’ve been hit by the flu every day.
What Causes POTS?
There’s no single cause of POTS. In fact, there are different types of POTS based on how the body is reacting.
1. Neuropathic POTS
Damage or poor function in the small nerve fibers that regulate blood vessel constriction, especially in the legs.
2. Hyperadrenergic POTS
The body produces too much norepinephrine (a stress hormone) when upright, leading to a high heart rate and jittery symptoms.
3. Hypovolemic POTS
Low blood volume. There’s simply not enough blood circulating to keep up with demands.
4. Autoimmune or Post-Viral POTS
Triggered by infections (like COVID-19, mononucleosis, or flu). Many cases are part of long COVID and may involve autoimmune reactions.
5. Secondary POTS
Develops alongside other conditions like:
- Ehlers-Danlos Syndrome (EDS)
- Mast Cell Activation Syndrome (MCAS)
- Autoimmune diseases
In our POTS clinic in Maryland, we frequently see patients whose symptoms began after a viral infection or major physical stress, such as surgery, pregnancy, or trauma.
Who Gets POTS?
POTS can affect anyone — men, women, children, and adults — but most commonly:
- Women aged 15–50
- Those with autoimmune or connective tissue disorders
- People recovering from COVID-19
- Patients with a family history of dysautonomia
Many people go years without a proper diagnosis, often being told their symptoms are due to anxiety, stress, or even laziness. This can be devastating for people already struggling to function.
How Is POTS Diagnosed?
The key feature of POTS is a rise in heart rate of:
- 30 bpm or more in adults
- 40 bpm or more in adolescents
…within 10 minutes of standing, without a major drop in blood pressure.
Common Diagnostic Tools:
- Orthostatic vital signs (checking heart rate and blood pressure while lying down, then standing)
- Tilt Table Test – A formal test that simulates the body’s response to standing
- Holter Monitor – A 24-hour heart monitor to catch abnormal rhythms
- Blood volume and hormone testing – To check for low plasma volume or high norepinephrine levels
- Autonomic testing – Measures sweat response, breathing, and nerve activity
Diagnosis Is Often Missed Because:
- Symptoms mimic other conditions
- Many providers aren’t trained in dysautonomia
- Labs and imaging often come back “normal”
This is why it’s important to work with a POTS specialist MD who knows what to look for and how to connect the dots.
How Is POTS Treated?
There’s no cure for POTS — but many people improve significantly with the right combination of lifestyle changes, medications, and supportive care.
1. Lifestyle Changes
- Increase salt (up to 10g/day with supervision)
- Hydrate (2–3 liters of water per day)
- Compression garments (especially waist-high)
- Raise the head of the bed to reduce morning symptoms
- Small, frequent meals (avoid large carb-heavy meals)
- Cool environments – Avoid heat exposure
2. Exercise
- Start slowly and horizontally (recumbent bike, rowing, swimming)
- Build core and leg strength
- Avoid upright exercise at first
- Use a structured rehab program if available
3. Medications (If Needed)
Depending on the type and severity of POTS:
- Beta-blockers – Control heart rate
- Midodrine – Helps raise blood pressure
- Fludrocortisone – Increases fluid retention
- Pyridostigmine – Improves nerve signaling
- Ivabradine – May be used off-label to lower heart rate
Treatment plans must be individualized, which is why working with a POTS doctor accepting new patients MD is so important.
How Long Does POTS Last?
This varies.
- Some people recover fully, especially if symptoms began after a virus or short illness.
- Others live with POTS long-term, with good and bad days.
- The majority improve with time and treatment, even if symptoms don’t fully disappear.
What matters most is early diagnosis, targeted support, and ongoing care from providers who understand the complexity of this condition.
Final Thoughts
POTS is real. It’s not rare, and it’s not “just in your head.” If you’ve been told you’re anxious, lazy, or just tired — but your body is screaming otherwise — it’s time to seek answers.
The symptoms may be invisible, but they are life-disrupting. Fortunately, with the right care team, tools, and strategies, they don’t have to be permanent.
At Diekman Dysautonomia, we specialize in the diagnosis and management of postural orthostatic tachycardic syndrome MD. We’ve helped hundreds of patients reclaim their lives — and we’re here to help you too.
