PoTS syndrome - why is my heart rate faster when I stand up?

Written by: Professor Melvin Lobo
Edited by: Nicholas Howley

Sometimes when we stand up suddenly we can feel a little dizzy – but what if this happens frequently, and your heart rate doesn’t go down? It could be a sign you’re affected by postural tachycardia syndrome , or PoTS syndrome. We’ve interviewed top cardiovascular physician Professr Melvin Lobo to find out how PoTS syndrome is diagnosed, and how it can be treated.

What is PoTS syndrome?

PoTS syndrome involves an elevate heart when changing posture and particularly when becoming upright from a seated or lying position. The important thing here is that the heart rate has to be above 120 beats per minute or by more than 30 beats per minute from the resting heart rate and that this needs to happen within 10 minutes of standing and also, this needs to be sustained. In PoTS syndrome, there is no change in blood pressure, even though patients with PoTS syndrome report feeling dizzy or lightheaded.

Who does PoTS syndrome affect?

The kind of person that mostly seems to experience symptoms of PoTS are women of childbearing age and pre-menopausal. You're much more likely to have POTS if you're a young woman – perhaps four or five times more likely than your male equivalent.

Are there any other symptoms?

As well as dizziness, patients can sometimes experience fainting, though this is not very common. The heart rate might be elevated when standing or you might experience palpitations.

PoTS can also cause a range of symptoms unrelated to the circulatory system. Some people might experience bloating, constipation, tummy pain, and sometimes a change in bowel habits. It can affect your attention span, memory, and your ability to complete tasks. It can even result in joint aches and pains, tendency to sprain ligaments, a tendency to easy bruising, and a tendency to scars that heal poorly. More recently, we have come to recognise increasing symptoms of anxiety and depression in patients with PoTS syndrome.

All in all the symptoms can be quite distressing and it’s important to get specialist help with their management.

How is PoTS syndrome treated?

The treatment for PoTS syndrome really depends on what the patient’s complaint is. If, for example, you have joint problems, this would be best managed by a rheumatologist. Similarly, a psychotherapist may be the appropriate person to help with cognitive issues such as memory problems.

When it comes to managing rapid heart rate or dizziness, there are drug treatments available, but in the first instance we always try to use non-drug treatments. This would consist of:

  • supporting the circulation with increased salt and fluid intake, avoiding dehydration, avoiding excessive hot weather, caffeinated products and alcohol
  • physical manoeuvres to avoid dizziness, including getting up slowly from a seated position and avoiding running upstairs
  • advice on how to manage being stood for a long time, including marching on the spot or to use rapid leg alternating movements or even stooping to prevent the fluid accumulating in the lower limbs
  • compression hosiery including thigh-length compression stockings and, in some cases, abdominal compression garments such as corsets or binders

There are only a few drug treatments for PoTS syndrome. These include Wellbutrin or Beta Blockers to keep the heart rate under control.

The key thing here is that the treatments are well-tolerated by the patient, and since with drugs this is not always the case, by and large I try to minimise the use of medication wherever possible in patients with PoTS syndrome.

By Professor Melvin Lobo
Internal medicine

Professor Melvin Lobo is a pioneering cardiovascular physician and clinical hypertension specialist, based in London. He is renowned for his work as a specialist in all forms of blood pressure disorders, and has been involved in a number of key clinical studies of device-based therapies for these conditions. He is an internationally recognised specialist in hypotension (low blood pressure) and highly variable BP disorders and circulatory conditions including PoTS and fainting disorders. His group has been involved in novel treatments (some first in man) to help patients with these diagnoses. To assist with the diagnosis and management of complex circulatory conditions, he set up the Barts Autonomic Laboratory in 2012 staffed with experts in neurophysiology and haemodynamics.

Professor Lobo is director of the renowned Bart's Blood Pressure Clinic in London, which has been recognised as a Hypertension Centre of Excellence by the European Society of Hypertension. The centre has become the premier UK centre for trials of device-based therapy of hypertension. He is a specialist advisor to NICE on interventional therapy of hypertension, and has authored UK and European guidance on renal denervation. Alongside his clinical work, Dr Lobo is also an NHS Reader in Cardiovascular Medicine Bart's and the London School of Medicine and Dentistry, and has contributed to a number of peer-reviewed articles for medical journals.

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