Heart Racing After Standing? POTS Symptoms & Medically Approved Next Steps

If your heart starts pounding when you stand up — and it keeps racing — you may wonder what's going on. Occasional lightheadedness can happen to anyone. But when a fast heartbeat, dizziness, or fatigue happens regularly after standing, it could point to POTS symptoms.

POTS stands for Postural Orthostatic Tachycardia Syndrome. It's a disorder that affects blood flow and the autonomic nervous system — the system that controls automatic body functions like heart rate and blood pressure.

Let's break down what's normal, what's not, and what medically approved next steps look like.

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What Happens in POTS?

When you stand up, gravity pulls blood into your legs and lower body. Normally, your body quickly adjusts:

• Blood vessels tighten
• Heart rate increases slightly
• Blood pressure stays stable

In people with POTS, this adjustment doesn't work properly. The heart rate increases abnormally fast — often by 30 beats per minute or more within 10 minutes of standing — without a major drop in blood pressure.

This rapid heart rate can cause uncomfortable and sometimes disruptive symptoms.

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Common POTS Symptoms

POTS symptoms can vary from mild to severe. They often worsen when standing and improve when lying down.

Common symptoms include:

• Rapid heartbeat (tachycardia) after standing
• Feeling faint or lightheaded
• Dizziness
• Fatigue
• Brain fog or trouble concentrating
• Shakiness
• Shortness of breath
• Chest discomfort
• Nausea
• Headaches
• Cold or discolored hands and feet

Some people also experience:

• Exercise intolerance
• Digestive issues
• Excessive sweating or reduced sweating
• Sleep disturbances

Symptoms often fluctuate. Some days may feel manageable, while others can be more difficult.

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Who Gets POTS?

POTS is most common in:

• Teenagers and young adults
• Women (especially ages 15–50)
• People recovering from viral illness
• Individuals with autoimmune conditions

It can also appear after pregnancy, surgery, or prolonged bed rest.

While POTS can significantly affect quality of life, it is not usually life-threatening. That said, symptoms should always be evaluated by a healthcare professional to rule out more serious conditions.

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When Is a Racing Heart Serious?

A fast heart rate after standing may be POTS — but it can also signal other conditions.

Seek urgent medical care if you experience:

• Chest pain that spreads to the arm, jaw, or back
• Fainting with injury
• Severe shortness of breath
• Confusion
• A heart rate consistently above 120–130 beats per minute at rest

These symptoms may indicate a cardiac or other serious issue and require immediate medical evaluation.

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How Is POTS Diagnosed?

There is no single blood test for POTS. Diagnosis typically involves:

1. Medical History

Your doctor will ask about:

• When symptoms started
• What triggers them
• Whether symptoms improve when lying down
• Recent illness or stress

2. Heart Rate and Blood Pressure Testing

This may include:

• Orthostatic vital signs (lying, sitting, standing measurements)
• Tilt table testing, which monitors heart rate and blood pressure while your body position changes

A hallmark of POTS is:

• Heart rate increase of 30 beats per minute or more in adults
• Symptoms lasting at least 3–6 months
• No significant drop in blood pressure

3. Blood Tests

To rule out:

• Anemia
• Thyroid disorders
• Electrolyte imbalances
• Dehydration

Because symptoms overlap with other conditions, proper medical evaluation is essential.

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Medically Approved Next Steps

If you suspect POTS symptoms, here are practical, medically supported steps:

1. Speak to a Doctor

Do not self-diagnose. A primary care physician or cardiologist can evaluate your symptoms and rule out dangerous causes.

If symptoms are persistent or affecting daily life, ask about referral to:

• A cardiologist
• A neurologist
• An autonomic specialist

Always speak to a doctor about symptoms that could be life-threatening or serious.

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2. Track Your Symptoms

Keep a simple log of:

• Heart rate readings (sitting and standing)
• Blood pressure readings (if available)
• Time of day symptoms occur
• Triggers (heat, dehydration, stress)

This information helps your doctor make an accurate diagnosis.

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3. Consider a Structured Symptom Review

If you're experiencing symptoms when standing and want to better understand what might be happening, you can take a free AI-powered Orthostatic Dysregulation symptom checker to help organize what you're feeling before your doctor's visit.

This type of tool can help organize your symptoms before your doctor's visit. It is not a diagnosis — but it can help guide the conversation.

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Lifestyle Changes That May Help POTS Symptoms

Many people with POTS improve with structured lifestyle adjustments. These are commonly recommended by physicians:

Increase Fluid Intake

• Aim for 2–3 liters of water daily (unless your doctor advises otherwise)

Increase Salt Intake

• Often 3,000–10,000 mg per day (only under medical guidance)
• Salt helps retain fluid and maintain blood volume

Compression Garments

• Waist-high compression stockings improve circulation

Gradual Exercise Program

Start slowly with:

• Recumbent biking
• Swimming
• Rowing

Avoid jumping straight into upright cardio. Deconditioning can worsen POTS symptoms, so a guided program is important.

Avoid Triggers

Common triggers include:

• Hot environments
• Prolonged standing
• Dehydration
• Large meals
• Alcohol

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Medications for POTS

When lifestyle changes aren't enough, doctors may prescribe medications such as:

• Beta blockers (to control heart rate)
• Fludrocortisone (to increase blood volume)
• Midodrine (to improve blood vessel constriction)
• Ivabradine (in select cases)

Medication plans are individualized. What works for one person may not work for another.

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Can POTS Go Away?

For some people — especially teenagers — POTS symptoms improve significantly over time.

Others may experience a chronic course with periods of improvement and flare-ups.

The good news:
With proper management, many individuals regain function and return to work, school, and exercise.

Early recognition and structured treatment make a difference.

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When to Be Especially Proactive

Make an appointment promptly if you have:

• Frequent fainting
• Symptoms worsening over weeks or months
• Inability to perform daily tasks
• New neurological symptoms
• Family history of heart disease

A racing heart after standing should never be ignored if it's persistent.

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The Bottom Line

If your heart races after standing and it keeps happening, it's worth paying attention.

POTS symptoms typically include:

• Significant heart rate increase upon standing
• Dizziness or lightheadedness
• Fatigue
• Brain fog
• Improvement when lying down

While POTS is usually not life-threatening, its symptoms can be disruptive and sometimes overlap with more serious conditions. That's why medical evaluation is essential.

Start by tracking your symptoms. Consider using a free AI-powered tool to check your Orthostatic Dysregulation symptoms and get personalized insights you can share with your doctor.

Most importantly:
If you experience chest pain, fainting, severe shortness of breath, or anything that feels dangerous, seek immediate medical care.

You deserve answers — and with the right support, POTS symptoms can often be managed effectively.