Heart Racing? Why POTS Syndrome Happens & Medically Approved Next Steps

If your heart starts racing when you stand up — sometimes accompanied by dizziness, brain fog, nausea, or even fainting — you might be wondering what's going on. One possible cause is POTS syndrome, short for Postural Orthostatic Tachycardia Syndrome.

POTS syndrome is a real and medically recognized condition that affects how your body regulates blood flow when you move from lying down to standing. While it can feel alarming, it is manageable — especially with the right medical guidance and lifestyle strategies.

Let's walk through what POTS syndrome is, why it happens, and what you can safely do next.

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What Is POTS Syndrome?

POTS syndrome is a disorder of the autonomic nervous system — the system that automatically controls heart rate, blood pressure, digestion, and temperature.

The hallmark feature of POTS syndrome is:

• A heart rate increase of 30 beats per minute (or more) within 10 minutes of standing
  • In teens, the increase is usually 40 beats per minute or more
• Symptoms that improve when lying down
• Symptoms lasting at least several months
• No significant drop in blood pressure (otherwise it may be orthostatic hypotension)

In simple terms: when you stand up, your heart overcompensates to keep blood flowing to your brain.

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Why Does POTS Syndrome Happen?

POTS syndrome is complex, and there isn't just one cause. It often involves a mix of factors.

Here are the most common contributors:

1. Blood Pooling in the Lower Body

When you stand, gravity pulls blood toward your legs and abdomen. In POTS syndrome:

• Blood vessels may not tighten properly
• Blood pools in the lower body
• Less blood returns to the heart and brain
• The heart beats faster to compensate

2. Autonomic Nervous System Dysfunction

The autonomic nervous system controls automatic body functions. In POTS syndrome, it may not regulate:

• Heart rate
• Blood vessel constriction
• Blood pressure

properly during position changes.

3. Low Blood Volume

Some people with POTS syndrome have lower circulating blood volume, making it harder for the body to maintain stable circulation.

4. Post-Viral or Post-Illness Triggers

POTS syndrome sometimes develops after:

• Viral infections
• Surgery
• Concussion
• Pregnancy
• Significant physical stress

In some cases, symptoms begin after COVID-19 or other viral illnesses.

5. Associated Conditions

POTS syndrome may occur alongside:

• Ehlers-Danlos syndrome (hypermobile type)
• Autoimmune conditions
• Mast cell activation disorders
• Chronic fatigue syndrome

Not everyone with POTS has these conditions — but they can overlap.

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Common Symptoms of POTS Syndrome

Symptoms usually happen when standing and improve with sitting or lying down.

Common symptoms include:

• Rapid heartbeat (palpitations)
• Dizziness or lightheadedness
• Brain fog or difficulty concentrating
• Fatigue
• Nausea
• Headaches
• Blurred vision
• Shakiness
• Shortness of breath
• Exercise intolerance
• Fainting (in some cases)

Symptoms can vary in intensity. Some people experience mild inconvenience. Others find it significantly disruptive.

If you're unsure whether your symptoms align with POTS or a related condition, consider using a free AI-powered symptom checker for Orthostatic Dysregulation to help identify potential patterns before your medical appointment.

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How Is POTS Syndrome Diagnosed?

Diagnosis should always be made by a medical professional.

Doctors typically use:

• Detailed medical history
• Physical exam
• Orthostatic vital signs (heart rate and blood pressure measured lying down and standing)
• Tilt table test (in some cases)

Because symptoms overlap with anxiety, dehydration, thyroid disorders, anemia, and heart rhythm problems, proper evaluation is important. POTS syndrome is a diagnosis of exclusion — meaning other causes must be ruled out first.

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Is POTS Syndrome Dangerous?

For most people, POTS syndrome is not life-threatening, but it can significantly impact quality of life.

That said:

• Fainting can increase fall risk.
• Severe dehydration can worsen symptoms.
• Underlying causes (like heart rhythm disorders) must be ruled out.

If you experience:

• Chest pain
• Severe shortness of breath
• Fainting with injury
• Irregular heart rhythms
• New neurological symptoms

seek urgent medical care.

When in doubt, speak to a doctor. Never assume persistent heart symptoms are "just POTS" without medical evaluation.

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Medically Approved Next Steps for POTS Syndrome

Treatment focuses on improving blood flow, stabilizing heart rate, and reducing symptoms. Most management plans combine lifestyle changes and, in some cases, medication.

1. Increase Fluid Intake

Staying well hydrated is foundational.

Doctors often recommend:

• 2–3 liters of fluids daily (unless medically restricted)
• Electrolyte solutions in some cases

Proper hydration increases blood volume and reduces heart rate spikes.

2. Increase Salt Intake (If Approved by Your Doctor)

Higher sodium intake can help retain fluid and improve circulation.

Important:

• Only increase salt under medical supervision.
• This is not safe for everyone (especially those with kidney or heart conditions).

3. Compression Garments

Medical-grade compression stockings (waist-high are often most effective) help:

• Reduce blood pooling
• Improve blood return to the heart
• Decrease dizziness

4. Physical Reconditioning

Exercise is one of the most evidence-supported treatments — but it must be gradual.

Recommended approach:

• Start with recumbent exercises (rowing, recumbent bike, swimming)
• Progress slowly to upright activities
• Focus on building leg and core strength

Over time, this improves autonomic regulation.

5. Medication (If Needed)

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

• Beta blockers (to control heart rate)
• Fludrocortisone (to increase blood volume)
• Midodrine (to tighten blood vessels)
• Ivabradine (in select cases)

Medication is individualized — not everyone needs it.

6. Manage Triggers

Common triggers include:

• Dehydration
• Heat exposure
• Large meals
• Alcohol
• Prolonged standing
• Sudden position changes

Simple adjustments — like standing up slowly — can reduce symptom spikes.

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Mental Health and POTS Syndrome

Because symptoms involve a racing heart, POTS syndrome is sometimes mistaken for anxiety. While anxiety can coexist, POTS is a physiological condition.

Living with unpredictable symptoms can understandably affect mood. Support, counseling, and stress management techniques may help improve overall resilience and coping.

Importantly, feeling dismissed or misunderstood can add stress. If you suspect POTS syndrome, advocate for a thorough medical evaluation.

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When to Speak to a Doctor

You should speak to a healthcare professional if you:

• Have persistent heart racing when standing
• Experience repeated dizziness or fainting
• Notice worsening symptoms
• Develop chest pain or irregular heartbeats
• Feel your symptoms are interfering with daily life

Heart-related symptoms should never be ignored. Even if it turns out not to be POTS syndrome, it's important to rule out serious conditions.

If anything feels severe, sudden, or life-threatening, seek emergency care immediately.

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The Bottom Line

POTS syndrome happens when your body struggles to regulate heart rate and blood flow upon standing. The heart races not because it's failing — but because it's trying to compensate.

While the condition can feel frightening, it is:

• Recognized by medical experts
• Often manageable
• Frequently improved with hydration, salt (if appropriate), exercise, and targeted care

The key is proper diagnosis and a structured treatment plan.

If you're experiencing symptoms, consider starting with a free AI-powered symptom checker for Orthostatic Dysregulation — and then bring those results to a qualified healthcare provider.

Most importantly: speak to a doctor about any persistent, worsening, or potentially serious symptoms. A racing heart deserves medical attention — and you deserve clear answers.