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Postural Orthostatic Tachycardia Syndrome

Postural Tachycardia Syndrome is an Abnormality of the Functioning of the Autonomic (involuntary) Nervous System. 
Testing for POTS

Credit: Stickman Communications 

Credit: Journal of Internal Medicine

Credit: Cheryl Harris - Researchgate

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  • Postural   -   Position of the Body

  • Tachycardia   -   Fast Heart Rate

  • Syndrome   -   A Combination of Symptoms

Postural tachycardia syndrome is an abnormality of the functioning of the autonomic (involuntary) nervous system. 

Definition and Diagnostic Criteria:
  • Patient must experience PoTS symptoms mostly when upright over a period of at least 3 months.

  • A sustained increase in heart rate of greater than 30 beats per minute within 10 minutes of standing.

  • Those aged 12-19 years require an increase of at least 40 beats per minute.

  • These criteria may not apply to those with a low heart rate when resting.

  • There is usually no drop in blood pressure on standing.

  • Many symptoms are experienced in the upright position (usually standing) and relieved by lying down. 

The Autonomic Nervous System

Postural Tachycardia Syndrome (PoTS) is an abnormality of the autonomic nervous system (ANS). A malfunctioning ANS is sometimes called ‘dysautonomia’. The autonomic nervous system is in charge of all bodily functions that we don’t have to think about, such as:


  • Heart rate and blood pressure regulation

  • Digestion

  • Bladder control

  • Sweating

  • Stress response

The sympathetic nervous system is part of the autonomic nervous system. It produces the ‘fight or flight’ or ‘stress’ response. When activated, a chemical called norepinephrine is released. Amongst other things, this causes an increase in heart rate and blood pressure.

What should Happen to my Blood when I Stand up?

When a healthy person stands up, blood vessels narrow, and heart rate increases slightly to maintain blood supply to heart and brain.

What Happens when I have PoTS and Stand up?

In PoTS, this automatic adjustment to upright posture is not working correctly, resulting in an excessive rise in heart rate, increased norepinephrine in the blood and altered blood flow to the brain. 

In some cases, PoTS has been reported to have developed after: 

  • An infection such as a viral or bacterial illness.

  • A life stressor such as pregnancy or surgery.

  • A traumatic event.

  • Immunisation.

However, a link with these potential triggers remains unclear.

Credit: PoTS UK - Click Here
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