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What is POTS?

Postural orthostatic tachycardia syndrome (POTS) is the most common and least severe type of dysautonomia, which is a malfunction of the autonomic nervous system (ANS). Without our knowing it, the ANS automatically controls our heart rate, blood pressure, gastrointestinal motility, and many other bodily functions. 


The cause of POTS is unknown. Some patients have it after a viral syndrome, like mononucleosis (Epstein-Barr virus). Others have it in association with joint hypermobility, where their joints are very stretchy (sometimes referred to as “double-jointed”). Still others have it after recurrent brain trauma or concussions. In a small number of people, it is associated with a metabolic disorder, a disease in which abnormal chemical reactions occur in the body.  
Because the exact cause of POTS is unknown, the syndrome cannot be cured, but symptoms can be managed. Some experts believe that up to 75% of patients with POTS may see their symptoms improve or disappear by age 21-25 years. However, those expectations may not be true for everyone. 

A condition commonly associated with POTS is ME (Myalgic encephalomyelitis) or CFS (Chronic fatigue syndrome).  

POTS Symptoms 

  • Dizziness

  • Passing out (syncope) 

  • Fast heart rate (tachycardia)

  • Chest pain

  • Headache

  • Severe fatigue

  • Difficulty concentrating
    (“brain fog”)

  • Feeling worse in very hot or very cold temperatures

  • Nausea or vomiting

  • Diarrhea and/or constipation 

  •  Feeling full quickly with

  • eating (early satiety)

  • Blood collecting in the legs
    (venous pooling)

  • Joint and/or muscle pain

  • Worsening symptoms with

  • bright lights or loud sounds

Not everyone is alike in their POTS diagnosis. Different people can have different combinations of these symptoms. It is important to know that symptoms may vary from hour to hour, day to day, week to week. There is also the “October slide,” in which some patients worsen as the autumn progresses. 

It may be difficult for family members, friends, teachers, etc., to understand these changes. They may question whether the illness is real. Work with your or your child’s school to help educators and administrators understand POTS, and tell them how they can best support your or your child’s education. Some children and teens even give talks in their schools to help their peers and teachers understand their illness. 

Nonpharmacologic Interventions


POTS symptoms can be controlled by using a combination of medications and nonpharmacologic treatments. Nonpharmacologic interventions include the following:




There are several options for treating POTS with medications. The goal is to match the prescribed medications with the symptoms being experienced. Some patients may require multiple medications for this reason. Additionally, some patients with POTS are very sensitive to medications, so very low doses are needed to avoid side effects. What works for one patient doesn’t always work for another, so it is important to be patient until the right therapy, or combinations of therapies, is found. The hope is to reduce symptoms so that important things, like the activities of daily living and education, can be easier for patients.

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