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What happens when standing up makes your heart race. A clear guide to the causes, diagnostic criteria, and the questions POTS patients ask most.
- Americans with POTS
- 1-3M
- Female Patients
- 80%
- Typical Age Range
- 15-50
Americans with POTS
Female Patients
Typical Age Range
What causes POTS?
There is no single cause. Most patients fall into one or more of these overlapping patterns.
Post-viral onset
A large share of cases begin after a viral illness, including mononucleosis and COVID-19.
Hypermobility & connective tissue
Stretchy blood vessels pool more blood, which is why POTS often overlaps with hEDS.
Autoimmune activity
Some patients have autoantibodies affecting the autonomic nerves that control blood vessels.
Deconditioning & prolonged illness
Extended bed rest reduces blood volume and heart size, amplifying upright symptoms.
Hormonal & pubertal changes
Onset frequently clusters around puberty, pregnancy, or major hormonal shifts.
Trauma or surgery
Physical trauma, concussion, or surgery can precede autonomic dysfunction.
How POTS is diagnosed
Diagnosis takes an average of several years. Coming prepared shortens that timeline.
- 1
Document your symptoms
Track standing heart rate, blood pressure, and symptoms for several weeks before your appointment.
- 2
Rule out other causes
Bloodwork, thyroid panels, and cardiac testing help exclude anemia, dehydration, and heart conditions.
- 3
Tilt table or active stand test
A sustained heart rate increase of 30+ bpm (40+ in teens) within 10 minutes of standing, without a drop in blood pressure, supports a POTS diagnosis.
- 4
Screen for related conditions
Many patients also have hypermobility, MCAS, ME/CFS, or autoimmune conditions worth evaluating.
- 5
Build a care team
Cardiology, neurology, or autonomic specialists plus physical therapy give the most complete support.
Frequently asked questions
Is POTS a form of anxiety?
No. POTS is a disorder of the autonomic nervous system. Adrenaline surges can feel like anxiety, which is why it is frequently misdiagnosed, but the underlying cause is circulatory, not psychological.
Can POTS go away?
Many people improve substantially with consistent management, and some — especially those whose POTS started after a virus or during adolescence — see symptoms resolve. Others manage it long term.
How much salt and water do I need?
Common guidance is 2-3 liters of fluid and increased sodium daily, but the right amount is individual. Confirm targets with your doctor, especially if you have kidney or blood pressure concerns.
Should I exercise if standing makes me worse?
Yes, but start horizontal. Recumbent bikes, rowing, and floor work build tolerance without triggering upright symptoms. Progress slowly over months, not weeks.
What compression is best?
Waist-high compression at 20-30 mmHg is most effective because it covers the abdomen, where a large share of pooling happens.