Dizzy When Standing? Why Your Heart Is Racing (POTS) & Medical Next Steps

If you feel dizzy when standing up, lightheaded in the shower, or notice your heart racing for no clear reason, you're not alone. One possible cause is POTS, short for Postural Orthostatic Tachycardia Syndrome.

POTS affects the way your body regulates heart rate and blood flow when you move from lying down to standing. While it can be frustrating and sometimes disruptive, it is manageable with the right medical support and lifestyle changes.

Let's break down what POTS is, why it happens, what symptoms to watch for, and what to do next.

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What Is POTS?

POTS (Postural Orthostatic Tachycardia Syndrome) is a condition that affects the autonomic nervous system — the part of your body that controls automatic functions like heart rate, blood pressure, and digestion.

When a healthy person stands up:

• Gravity pulls blood toward the legs.
• Blood vessels tighten.
• Heart rate increases slightly.
• Blood flow to the brain stays steady.

In people with POTS:

• Blood pools in the lower body.
• The heart beats much faster to compensate.
• Blood flow to the brain may temporarily decrease.
• Symptoms like dizziness or faintness occur.

Official Diagnostic Criteria for POTS

A diagnosis of POTS typically requires:

• A heart rate increase of 30 beats per minute (bpm) or more within 10 minutes of standing
  (40 bpm in teens)
• No significant drop in blood pressure
• Symptoms lasting at least 3–6 months

Diagnosis is usually confirmed through:

• A tilt table test
• Active standing test
• Heart monitoring
• Blood work to rule out other causes

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Common Symptoms of POTS

Symptoms can vary widely. Some people have mild symptoms, while others struggle daily.

Common POTS Symptoms:

• Dizziness when standing
• Rapid heartbeat (tachycardia)
• Lightheadedness
• Fatigue
• Brain fog
• Headaches
• Nausea
• Exercise intolerance
• Shakiness
• Shortness of breath
• Fainting (in some cases)

Symptoms often improve when lying down.

Many people notice symptoms:

• In hot environments
• After illness
• During dehydration
• Around menstrual cycles
• After long periods of standing

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Why Does POTS Happen?

There isn't one single cause. POTS is considered a syndrome, meaning it can result from different underlying problems.

Possible contributors include:

• Autonomic nervous system dysfunction
• Viral infections (some cases develop after viral illness)
• Autoimmune conditions
• Deconditioning (after prolonged bed rest)
• Joint hypermobility disorders like Ehlers-Danlos syndrome
• Blood volume abnormalities
• Genetic predisposition

For some, symptoms start after:

• Pregnancy
• Surgery
• Trauma
• Significant illness

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POTS vs. Vasovagal Syncope

It's important not to confuse POTS with vasovagal syncope, another condition that can cause dizziness and fainting.

• POTS: Heart rate increases significantly without a major blood pressure drop.
• Vasovagal syncope: Blood pressure drops suddenly, often causing fainting.

If you're experiencing sudden fainting episodes or dizziness that results in loss of consciousness, it may be helpful to check your symptoms with a free AI assessment to better understand what might be causing them before your doctor's visit.

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When Should You See a Doctor?

You should speak to a doctor if you experience:

• Frequent dizziness
• Unexplained fainting
• Ongoing rapid heart rate
• Chest pain
• Shortness of breath
• Severe fatigue affecting daily life

While POTS itself is not typically life-threatening, some symptoms can overlap with serious heart or neurological conditions. It's important to rule out:

• Heart rhythm disorders
• Structural heart disease
• Anemia
• Thyroid disorders
• Adrenal problems
• Neurological conditions

If you ever experience:

• Sudden chest pain
• Fainting with injury
• Severe shortness of breath
• Confusion
• Symptoms that come on suddenly and severely

Seek emergency medical care immediately.

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How Is POTS Treated?

There is no single "cure" for POTS, but many people improve significantly with proper management.

Treatment usually focuses on improving blood flow and stabilizing heart rate.

1. Lifestyle Changes (First-Line Treatment)

Doctors often recommend:

• Increased fluid intake (2–3 liters per day)
• Higher salt intake (if medically appropriate)
• Wearing compression stockings
• Gradual, structured exercise programs
• Avoiding long periods of standing
• Elevating the head of the bed slightly
• Small, frequent meals

Exercise is especially important. Programs often start with:

• Recumbent cycling
• Swimming
• Rowing

Then gradually progress to upright exercise.

2. Medications

If lifestyle changes are not enough, medications may help, such as:

• Beta blockers
• Fludrocortisone
• Midodrine
• Ivabradine (in some cases)

Medication decisions are individualized and should always be discussed with a physician experienced in managing POTS.

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What Is the Long-Term Outlook for POTS?

The outlook varies.

• Some people improve significantly over time.
• Teens and young adults often see symptom improvement over several years.
• Others may experience chronic symptoms that require ongoing management.

The good news:
POTS does not typically shorten life expectancy.

However, it can impact quality of life — which is why early recognition and treatment matter.

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What You Can Do Right Now

If you suspect POTS, consider taking these steps:

• Track your symptoms (when they happen, triggers, heart rate changes)
• Measure heart rate lying down vs. standing
• Stay hydrated
• Avoid sudden position changes
• Make an appointment with your primary care doctor or cardiologist

Bring detailed symptom notes to your appointment. This helps doctors assess patterns more quickly.

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Important: Don't Self-Diagnose

While it's helpful to research symptoms, many conditions can cause dizziness and a racing heart, including:

• Anxiety disorders
• Thyroid disease
• Heart rhythm disorders
• Dehydration
• Medication side effects
• Anemia

Getting proper medical evaluation is essential.

If anything feels severe, new, or life-threatening, speak to a doctor immediately or seek urgent care.

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Final Thoughts

Feeling dizzy when standing and noticing your heart racing can be unsettling. POTS is a real, medically recognized condition, and you are not imagining your symptoms.

The key points to remember:

• POTS involves an abnormal heart rate increase when standing.
• It's diagnosed through specific heart rate criteria.
• It is manageable with lifestyle changes and sometimes medication.
• It is not usually life-threatening, but it does require medical evaluation.

If you're experiencing these symptoms and want to better understand what might be causing them, you can take a free symptom assessment to help guide your conversation with your healthcare provider.

Most importantly:
Speak to a doctor about persistent dizziness, fainting, or heart racing — especially if symptoms are severe, worsening, or interfering with daily life.

Early evaluation leads to better outcomes and greater peace of mind.