Feeling lightheaded or dizzy after standing up is a fairly common experience.

Everyone at some point has probably experienced this drop in blood pressure, called orthostatic hypotension. It happens because blood tends to pool in our legs as we sit, and when we stand and our body takes a beat to compensate.

There is another condition that can cause lightheadedness upon standing: postural orthostatic tachycardia syndrome (POTS), and its symptoms are not as easily resolved.

Understanding symptoms and types of POTS

One of the main symptom of POTS, besides palpitations, is lightheadedness, mainly after standing from lying or sitting down, because of decreased blood flow to the brain.

Other symptoms of POTS can include:

  • Heart palpitations and shaking or tremors
  • Rapid heartbeat within 10 minutes of standing
  • Dizziness and passing out
  • Blurred vision, ears ringing
  • Brain fog
  • Fatigue
  • Insomnia
  • Gastrointestinal symptoms like nausea, bloating, diarrhea or constipation
  • Headaches
  • Burning, tingling, or numbness in the extremities

There are three main subtypes of POTS, which may overlap in one person:

  • Hypermobile POTS, which is seen in patients with joint hypermobility, and includes loose blood vessels that do not constrict well enough to fight against gravity and return blood to the heart.
  • Neuropathic POTS, which is connected to impaired nerve function, specifically in the tiny nerve fibers that control blood vessel constriction. This can cause blood to pool in the lower extremities, and cause burning or tingling in the legs, dizziness and fatigue.
  • Hyperadrenergic POTS, which is indicated by higher levels of norepinephrine in someone’s blood, which affects the sympathetic nervous system. This can cause tremors, excessive sweating, heart palpitations and high blood pressure when someone stands.

“We tend to see the neuropathic POTS cases a lot, especially after someone was infected with a virus, but we also see a lot of hypermobile patients with POTS,” said Lawrence Zeidman, MD, a neurologist and Director of the Neuromuscular and Autonomic Section at Endeavor Health’s Neurology Department. “Defining the subtype of POTS can help us decide on the best treatment.”

Concussion can be associated with POTS, and patients with mast cell activation syndrome develop POTS, Dr. Zeidman said. This is a rare condition where mast cells, which control how the body reacts to things like allergens, activate without a clear trigger. These patients often have a multidisciplinary treatment plan.

“Many female patients report more severe symptoms around the time of menstruation,” said Caroline Ball, MD, cardiologist with Endeavor Health.

POTS is more common in women than men, and primarily affects people between ages 15 and 50. POTS is estimated to affect between 1 and 3 million people in the United States.

How POTS is diagnosed and treated

There are certain drugs that can help to treat POTS, and physicians may recommend lifestyle changes such as drinking more water, increasing sodium or electrolyte intake or wearing compression garments.

“POTS often involves a fair amount of deconditioning, and patients benefit from a graded exercise program that’s specially tailored to POTS to help them improve,” Dr. Zeidman said.

Graded exercise programs build cardiovascular capacity and strength with exercises designed to improve exercise tolerance.

“POTS may improve significantly with lifestyle changes and physical therapy (PT) and occupational therapy (OT) to teach the graded exercise program, called the Levine protocol, the Dallas protocol, or the CHOP protocol,” Dr. Zeidman said.

Through the Endeavor Health POTS multidisciplinary program, new POTS cases can get an evaluation by neurology, PT, and OT all in the same visit, Dr. Zeidman said.

There are several tests doctors use to diagnose POTS. They may monitor a person’s blood pressure and heart rate while lying down, sitting and standing; measure heart, breathing and sweating functions in Endeavor Health’s Autonomic Laboratory; order blood tests to check thyroid, adrenaline, iron and other levels; and check heart function with a 24-hour monitor, echocardiogram and electrocardiogram.

If you experience symptoms of POTS, make an appointment with our neurology or cardiology departments.