Postural Orthostatic Tachycardia Syndrome: Causes, Symptoms, and Treatment
Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Postural Orthostatic Tachycardia Syndrome?
A cardiologist, a heart doctor, or a neurologist, a brain and nerve doctor, often helps diagnose and treat postural orthostatic tachycardia syndrome, also called POTS. Care may involve more than one specialist. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is postural orthostatic tachycardia syndrome?
POTS is part of a group of disorders that involve orthostatic intolerance. This means symptoms that happen when a person stands up and can be relieved by lying down. In the name, postural means linked to body position, orthostatic means related to standing, and tachycardia means a rapid heart rate.
In people with POTS, the body's signals for standing up break down. The blood vessels in the lower body do not tighten enough, and the heart beats much faster than it should.
Symptoms
The classic symptom of POTS is a fast heartbeat. It usually gets better when the person lies down again. POTS affects everyone differently. Some people have mild symptoms, while for others it has a big impact on daily life. Other symptoms include:
- Dizziness or lightheadedness.
- Fainting or nearly fainting.
- Noticeable heartbeats, called palpitations.
- Shortness of breath.
- Chest pain (see the emergency signs below).
- Weakness and extreme tiredness.
- Headaches and blurred or tunnel vision.
- Stomach and digestion problems, such as nausea, diarrhea, constipation, bloating, and belly pain.
- Brain fog, which means trouble with thinking, memory, and focus.
Symptoms may come and go over time. In most cases, they improve over time, though some may last a long time.
Causes and who gets it
Scientists do not know exactly what causes POTS. It often begins after pregnancy, major surgery, puberty, trauma, or a viral illness. Some people with long COVID have developed POTS. Anyone can get POTS, but it mainly affects people between 15 and 50 and is more common in women than in men. A family history of POTS or related conditions raises the risk. Some people with hypermobile Ehlers-Danlos syndrome, an inherited disorder of connective tissue, may also be diagnosed with POTS. Some medicines can cause or worsen POTS symptoms, including antidepressants and some medicines for high blood pressure and heart conditions. Talk with a doctor before you start any new medicine. Symptoms can get worse with heat, standing for a long time, not drinking enough fluids, and alcohol.
How doctors diagnose it
Diagnosis can be hard because the symptoms often look like other conditions. Doctors review your medical history and symptoms. They may also measure heart rate and blood pressure as you change position. Adults might have POTS if the heart rate rises by more than 30 beats a minute within 10 minutes of standing, without a big blood pressure change. For people under 20, a rise of at least 40 beats a minute could signal POTS.
Tests can include:
- An active stand test, where a doctor checks your blood pressure and heart rate before and after you stand up, sometimes several times.
- A tilt table test, where you lie on a table that is tilted upright while your heart rate and blood pressure are watched.
- Blood tests and an electrocardiogram, or ECG, a heart rhythm test, to look for other causes.
- A specialist may add an echocardiogram, a heart ultrasound, and 24-hour blood pressure and heart rate monitoring.
Treatment
There is currently no cure for POTS, but it can be managed with lifestyle changes or medicines. Lifestyle steps can include:
- Eating more salt and staying hydrated, which can help raise blood volume.
- Drinking at least 16 ounces of water before getting up for a temporary boost.
- Wearing compression garments, which squeeze the lower body to improve blood flow.
- Gentle exercise such as walking or swimming, stopping if symptoms start.
Doctors may also prescribe medicines. Fludrocortisone and midodrine can help by raising blood volume and tightening blood vessels. They can offer short-term relief, and researchers are still learning how well they work over the long term. Some people get relief from beta-blockers, which slow the heart rate and lower blood pressure. If you suddenly feel faint, try lying down and raising your legs until you feel better.
When to see a doctor
If you have symptoms of POTS, it is important to get them checked out. Call 911 or go to the emergency room if you have chest pain or discomfort that lasts two minutes or more, sudden weakness or a sudden change in vision, confusion or trouble waking up, or if you cannot speak.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either can listen to your symptoms, check your heart rate and blood pressure before and after you stand up, and refer you to a specialist if needed.
Common questions
Can POTS be cured?
There is currently no cure for POTS, but it can be managed. In most cases, symptoms improve over time.
Who is most likely to get POTS?
POTS mainly affects people between the ages of 15 and 50, and it is more common in women than in men.
Can long COVID lead to POTS?
Yes, some people with long COVID have developed POTS. Scientists are still working to understand why.
What should I do if I feel faint?
Try lying down and raising your legs until you feel better.
Sources
- National Institute of Neurological Disorders and Stroke - Postural Tachycardia Syndrome (POTS)
- NHS - Postural tachycardia syndrome (PoTS)
- NIH News in Health - Recognizing POTS
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
