Evidence-based fatigue guide
POTS (Postural Tachycardia Syndrome) and Fatigue
Postural orthostatic tachycardia syndrome, usually called POTS, is a condition affecting the autonomic nervous system's control over heart rate and blood flow when moving from lying or sitting to standing. It causes a disproportionate increase in heart rate on standing, often alongside dizziness and profound fatigue, and it disproportionately affects younger people, particularly women.
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This article is for general education only. It does not diagnose conditions or replace advice from a qualified healthcare professional.
Key takeaways
- POTS causes an abnormally large increase in heart rate within minutes of standing, often alongside dizziness and fatigue.
- It commonly develops after a viral illness, pregnancy, surgery, or a prolonged period of bed rest.
- Increasing fluid and salt intake, as advised by a clinician, and gradual exercise are common management strategies.
- Fainting or fatigue severe enough to prevent standing needs prompt medical evaluation.
Common symptoms
- A rapid heartbeat that develops within about 10 minutes of standing
- Dizziness or lightheadedness upon standing, sometimes progressing to fainting
- Profound fatigue, often worse in the morning or after standing for a period
- Brain fog or difficulty concentrating, especially when upright
- Shakiness, nausea, or a feeling of being unwell that improves with lying down
- Exercise intolerance, with symptoms worsening after physical activity
- Symptoms that are often worse in hot weather or after a large meal
Possible causes
- A dysfunction in the autonomic nervous system's regulation of heart rate and blood vessel tone
- Often develops after a viral infection, including some cases following COVID-19
- Pregnancy or a period of prolonged bed rest or deconditioning
- Autoimmune conditions, which are more common in some people with POTS
- A genetic predisposition in some individuals
- Reduced blood volume or impaired blood vessel constriction upon standing
Self-care guidance
These low-risk steps may help but are not a treatment plan. Speak with a healthcare professional before starting supplements or stopping medication.
- Increase fluid and salt intake as specifically advised by your healthcare provider, since this helps expand blood volume for many people
- Rise slowly and consider physical counter-maneuvers, such as crossing your legs or tensing your leg muscles before standing
- Wear compression garments on the legs and abdomen if recommended by your clinician
- Begin a structured, gradual exercise program, ideally recumbent exercises like swimming or rowing at first, as tolerated
- Eat smaller, more frequent meals if symptoms worsen after large meals
- Avoid prolonged standing still, and elevate the head of your bed slightly if advised by your care team
When to see your doctor
- You notice a racing heart, dizziness, and fatigue consistently on standing
- Symptoms are affecting your ability to work, attend school, or manage daily activities
- You suspect POTS developed after a recent viral illness, pregnancy, or period of bed rest
- You want guidance on a safe, structured exercise program for POTS
When to seek emergency care
Call your local emergency number or go to an emergency department immediately if you notice:
- Fainting, especially with injury or occurring while driving
- Chest pain or severe shortness of breath
- A heart rate that remains very fast and does not settle with rest
- Sudden weakness, numbness, or difficulty speaking
- Severe dehydration, such as inability to keep fluids down
Frequently asked questions
What does POTS stand for?
POTS stands for postural orthostatic tachycardia syndrome, a condition in which standing up triggers an abnormally large increase in heart rate, often alongside dizziness and fatigue.
Who typically develops POTS?
POTS disproportionately affects younger people, particularly women, and often develops after a viral illness, pregnancy, surgery, or a prolonged period of bed rest, though it can occur without an obvious trigger.
Does drinking more water and salt really help POTS?
For many people, yes — increasing fluid and salt intake, under a clinician's guidance, helps expand blood volume and can reduce the severity of symptoms, though this should be tailored to your individual health situation.
Can exercise make POTS worse?
Intense or upright exercise can initially worsen symptoms, which is why a gradual, structured program, often starting with recumbent exercises like swimming or rowing, is generally recommended under medical guidance.
Conclusion
POTS causes a distinctive combination of a racing heart, dizziness, and profound fatigue on standing, driven by the autonomic nervous system's regulation of heart rate and blood flow. While there is no single cure, increased fluid and salt intake, compression garments, and a carefully structured exercise program help many people manage symptoms, and fainting or chest pain alongside POTS symptoms should be evaluated urgently.
References
Public health sources are listed in this order: USA, UK, Canada, Australia.