Postural Orthostatic Tachycardia Syndrome (POTS)
Postural Orthostatic Tachycardia Syndrome (POTS) is a condition that causes your heart to pump too fast for too long after you stand up. It can make you feel dizzy, sweaty, tired, and sick. It’s caused by a problem with the signals your nervous system sends to control your heart rate and blood flow when you stand.
Research at Vanderbilt has helped improve understanding of POTS and identify treatments that may reduce symptoms and improve daily life.
POTS: Available Treatments
Treatment for POTS is individualized and often includes a combination of lifestyle changes, physical strategies and medications to improve symptoms and daily function.
Lifestyle Approaches
These are usually first-line treatments:
- Increase fluids and salt intake (to support blood volume).
- Physical conditioning/exercise programs (especially recumbent or gradual training).
- Abdominal (splanchnic) compression: May help support blood pressure and improve symptoms when used with propranolol.
- Read more in PubMed: Splanchnic venous compression enhances β-blockade in POTS
- Avoid triggers (heat, dehydration, prolonged standing).
Medications
Propranolol (beta-blocker): Low doses can reduce heart rate and improve symptoms, often more effectively than higher doses.
Pyridostigmine: Can lower heart rate and improve symptoms without significantly affecting blood pressure.
- PubMed: Pyridostigmine in the treatment of postural orthostatic tachycardia: a single-center experience
Desmopressin (DDAVP): May temporarily reduce heart rate and improve symptoms by increasing fluid retention, though long-term use requires monitoring.
Fludrocortisone
- Helps the body retain salt and fluid to increase blood volume.
Midodrine
- Helps tighten blood vessels and improve blood pressure Ivabradine (in select patients). Lowers heart rate without lowering blood pressure.
Guanfacine
- Calms the nervous system.
- May reduce heart rate and adrenaline-related symptoms.
- Can help with feeling overstimulated.
Clonidine
- Similar to guanfacine but may act faster.
- Helps reduce blood pressure swings and heart rate.
- Sometimes used for hyperadrenergic POTS.
Methyldopa
- Lowers sympathetic (stress-related) activity.
- May help stabilize blood pressure and reduce symptoms.
Other Considerations
- Treatment often requires trial and adjustment.
- Many patients benefit from a combination approach.
- Addressing related issues such as sleep, fatigue, and deconditioning is important.
- Note: Treatment plans should always be guided by a healthcare provider based on individual symptoms and medical history.