Grove Neurology
Andrew M. Lerman, MD
Adult Neurology and Neurophysiology located in Coconut Grove, Coral Gables and Miami, FL
Racing heart, dizziness, and fatigue every time you stand up? POTS is a disorder of the autonomic nervous system that affects how your body regulates heart rate and blood flow with changes in position. It's frequently misdiagnosed as anxiety or dehydration, leaving patients without answers for years.
At Grove Neurology in Miami, FL, we provide comprehensive evaluation and individualized treatment for POTS and related autonomic disorders.
Question and Answers
POTS stands for Postural Orthostatic Tachycardia Syndrome. It's a condition affecting the autonomic nervous system, the part of your body that automatically controls things like heart rate, blood pressure, and blood flow.
Normally, when you stand up, your body makes quick adjustments to keep blood flowing to your brain. In POTS, those adjustments don't work properly. Blood pools in the lower body, and your heart compensates by beating much faster, typically increasing by 30 beats per minute or more within ten minutes of standing.
The result is a range of symptoms that can include lightheadedness, a racing or pounding heartbeat, fatigue, brain fog, headaches, nausea, and difficulty tolerating exercise. Symptoms often improve when lying down.
POTS is more common than many people realize, particularly in women between adolescence and their late thirties, and it frequently follows a viral illness, surgery, pregnancy, or physical trauma.
There isn't one single cause, which is part of what makes POTS challenging to diagnose. In many patients, symptoms begin after a triggering event such as a viral illness, COVID-19, mononucleosis, surgery, pregnancy, a concussion, or a period of prolonged bed rest.
Researchers have identified several underlying mechanisms. Some patients have reduced blood volume. Others have small fiber neuropathy affecting the nerves that control blood vessel constriction. In a subset of patients, POTS appears to be autoimmune, with antibodies interfering with autonomic signaling. POTS also occurs more frequently in people with hypermobile Ehlers-Danlos syndrome, mast cell activation syndrome, and autoimmune conditions.
Identifying which mechanism is driving your symptoms helps guide treatment, which is why a thorough evaluation matters.
Diagnosis begins with a detailed history and physical exam. The hallmark finding is a sustained heart rate increase of at least 30 beats per minute (40 in adolescents) within ten minutes of standing, without a significant drop in blood pressure.
This can be measured with a tilt table test or a bedside standing test. Because POTS shares symptoms with many other conditions, your evaluation will typically include bloodwork and cardiac testing to rule out other causes such as anemia, thyroid dysfunction, adrenal disorders, and arrhythmias. Additional autonomic testing may be recommended depending on your presentation.
The average patient waits years for a correct diagnosis. A focused neurologic evaluation can shorten that considerably.
POTS is generally considered a manageable condition rather than a curable one, though outcomes are often better than patients expect. Many people improve substantially with treatment, and some, particularly younger patients and those whose POTS followed a viral illness, see symptoms resolve over time.
The goal of treatment is to reduce symptoms enough that you can return to work, school, exercise, and daily life. That's an achievable outcome for the majority of patients who receive appropriate care.
Treatment is individualized and usually combines several approaches.
Foundational strategies include increasing fluid and sodium intake, wearing compression garments, and following a structured, gradual exercise reconditioning program. Exercise is one of the most effective interventions, though it must be started carefully and progressed slowly, often beginning with recumbent activity.
Medications may be added when lifestyle measures aren't enough. Options include agents that slow heart rate, increase blood volume, or improve blood vessel constriction. Treating coexisting conditions such as migraine, mast cell disorders, or sleep disturbance is also an important part of the plan.
Most patients need a period of adjustment to find the right combination, and regular follow-up is key.
If you experience persistent dizziness, a racing heartbeat when standing, unexplained fatigue, or brain fog that interferes with daily activities, an evaluation is worthwhile, especially if these symptoms began after an illness or injury.
You should also seek care if you've already been told your symptoms are anxiety or dehydration but haven't improved with those explanations. POTS is real, measurable, and treatable, and you deserve a clear answer.
