POTS Disease? Why Your Heart Is Racing & Medically Approved Next Steps

If your heart starts pounding when you stand up—sometimes accompanied by dizziness, brain fog, nausea, or even fainting—you may be wondering whether it's anxiety, dehydration, or something more serious. One possible cause is POTS disease, short for Postural Orthostatic Tachycardia Syndrome.

POTS disease is a real, medically recognized condition that affects how your body regulates heart rate and blood flow when you move from lying down to standing. While it can feel frightening, especially when your heart is racing, there are clear diagnostic steps and proven treatments that can help.

Let's break down what POTS disease is, why it happens, and what you should do next.

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What Is POTS Disease?

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

The key feature of POTS disease is:

• A heart rate increase of 30 beats per minute (or more) within 10 minutes of standing
  (40 bpm in adolescents)
• Without a significant drop in blood pressure

In simple terms: when you stand up, your heart races abnormally fast.

Normally, when you stand, gravity pulls blood into your lower body. Your nervous system quickly tightens blood vessels and slightly increases heart rate to keep blood flowing to your brain.

In POTS disease, that adjustment doesn't work properly. Your body overcompensates by dramatically increasing your heart rate.

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Common Symptoms of POTS Disease

Not everyone experiences POTS disease the same way. Symptoms can range from mild to debilitating.

Common symptoms include:

• Rapid heartbeat upon standing
• Dizziness or lightheadedness
• Fainting or near-fainting
• Brain fog or trouble concentrating
• Fatigue that doesn't improve with rest
• Nausea
• Headaches
• Shakiness
• Shortness of breath
• Chest discomfort
• Cold or discolored hands and feet

Symptoms typically improve when lying down.

POTS disease can significantly affect daily life. Some people struggle to stand long enough to cook a meal or shower. Others are able to function but feel constantly exhausted.

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Who Gets POTS Disease?

POTS disease most commonly affects:

• Women (especially ages 15–50)
• People after a viral illness
• Individuals with autoimmune conditions
• Those with connective tissue disorders (such as hypermobile Ehlers-Danlos syndrome)
• People after pregnancy, surgery, or trauma

In many cases, symptoms begin after a triggering event like a viral infection. Researchers have also observed increased cases following COVID-19.

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Why Is Your Heart Racing?

In POTS disease, several mechanisms may be involved:

• Blood pooling in the legs and abdomen
• Reduced blood volume
• Overactive sympathetic nervous system ("fight or flight" response)
• Autoimmune-related nerve dysfunction
• Deconditioning after illness

The racing heart is your body's attempt to maintain blood flow to the brain. It's a compensation mechanism—not a heart defect.

Importantly, POTS disease is not usually caused by structural heart disease. However, it's essential to rule out other serious causes of tachycardia before confirming the diagnosis.

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How Is POTS Disease Diagnosed?

There is no single blood test for POTS disease. Diagnosis is based on:

1. Medical History

Your doctor will ask:

• When symptoms started
• What triggers them
• Whether you faint
• Any recent illness or stressors

2. Orthostatic Vital Signs

Heart rate and blood pressure are measured:

• Lying down
• Sitting
• Standing (for up to 10 minutes)

3. Tilt Table Test

In some cases, you lie on a motorized table that tilts upright while heart rate and blood pressure are monitored.

4. Blood Tests

To rule out:

• Anemia
• Thyroid disorders
• Dehydration
• Electrolyte imbalances
• Autoimmune conditions

Because symptoms can overlap with anxiety, panic disorders, or chronic fatigue syndrome, proper evaluation is essential.

If you're experiencing these symptoms and want to understand your risk before your doctor's appointment, try this free AI-powered Orthostatic Dysregulation symptom checker to see if your symptoms align with this condition.

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Medically Approved Next Steps for POTS Disease

If you suspect POTS disease, here are the evidence-based steps to take:

1. Speak to a Doctor

This is critical.

A racing heart, fainting, chest pain, or shortness of breath can sometimes signal life-threatening conditions such as:

• Heart rhythm disorders
• Blood clots
• Severe dehydration
• Internal bleeding
• Cardiac structural disease

If symptoms are sudden, severe, or worsening—seek urgent care.

Even if symptoms seem mild, schedule an appointment with your primary care doctor or a cardiologist. Early diagnosis improves outcomes.

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2. Increase Fluid Intake

Many people with POTS disease have low circulating blood volume.

Doctors often recommend:

• 2–3 liters of fluids daily
• Electrolyte-rich drinks
• Adequate salt intake (if medically appropriate)

Never increase salt dramatically without medical supervision—especially if you have high blood pressure or kidney disease.

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3. Gradual Exercise Program

Exercise is one of the most effective treatments—but it must be done carefully.

Start with:

• Recumbent biking
• Rowing
• Swimming

Avoid starting with upright cardio.

The goal is gradual reconditioning to improve blood vessel tone and heart efficiency.

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4. Compression Garments

Waist-high compression stockings can:

• Reduce blood pooling
• Improve circulation
• Decrease dizziness

Medical-grade compression (20–30 mmHg or higher) is often recommended.

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5. Medication (If Needed)

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

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

Medication choice depends on your specific symptom pattern.

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6. Identify and Treat Underlying Causes

In some people, POTS disease is secondary to:

• Autoimmune disease
• Mast cell activation
• Hormonal imbalance
• Neuropathy

Addressing the root cause can significantly improve symptoms.

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Is POTS Disease Dangerous?

POTS disease is usually not fatal, but it can be life-altering.

The biggest risks are:

• Injury from fainting
• Severe deconditioning
• Reduced quality of life
• Mental health strain

Importantly, POTS disease does not typically lead to heart failure or permanent heart damage. However, symptoms should always be evaluated to rule out more serious cardiac conditions.

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Can POTS Disease Improve?

Yes.

Many patients see improvement over time, especially with:

• Structured exercise
• Hydration strategies
• Appropriate medication
• Treating underlying causes

Adolescents often improve significantly over several years. Adults may experience symptom fluctuations, with periods of improvement and flare-ups.

Recovery is often gradual, not immediate.

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When to Seek Emergency Care

Call emergency services or go to the ER if you experience:

• Chest pain that feels crushing or spreading
• Severe shortness of breath
• Fainting with injury
• Sudden neurological symptoms (weakness, slurred speech)
• A heart rate consistently above 150 bpm at rest

Do not assume it's just POTS disease.

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Final Thoughts: What Should You Do Now?

If your heart races when you stand and you feel dizzy or unwell, don't ignore it—but don't panic either.

Here's a practical plan:

• Track your symptoms and heart rate.
• Stay hydrated.
• Avoid prolonged standing when possible.
• Use a free Orthostatic Dysregulation symptom checker to understand what your symptoms might mean.
• Schedule an appointment with your doctor for proper evaluation.

POTS disease is real. It can be disruptive. But with proper diagnosis and medically guided treatment, many people regain stability and function.

Most importantly, always speak to a doctor about persistent rapid heart rate, fainting, chest pain, or anything that could be life-threatening or serious. Getting evaluated is not overreacting—it's responsible care.

Your racing heart may have an explanation. And there are real, evidence-based steps that can help.