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Living with unexplained dizziness, rapid heart rate, fatigue, and brain fog can quietly disrupt every part of daily life. Many patients spend months—or even years—searching for answers before finally hearing a name for what they are experiencing: POTS, or Postural Orthostatic Tachycardia Syndrome.
For people newly diagnosed, the first questions are almost always the same: Is POTS heart disease? Can it be treated? Will I ever feel normal again?
The good news is that with the right diagnosis, a personalized treatment plan, and expert cardiovascular guidance, many patients experience real improvement. Physicians like Dr. Cynthia Thaik, a board-certified cardiologist with deep experience in complex autonomic and heart rhythm conditions, emphasize that understanding POTS is the first step toward regaining control.
This guide walks through how doctors diagnose and treat POTS syndrome, what patients should know about heart involvement, and how treatment strategies are tailored to help people reclaim their quality of life.
What Is POTS Syndrome?
Postural Orthostatic Tachycardia Syndrome (POTS) is a disorder of the autonomic nervous system—the system responsible for regulating involuntary body functions like heart rate, blood pressure, digestion, and temperature control.
POTS is defined by:
- A sustained heart rate increase of 30 beats per minute or more (or over 120 bpm) within 10 minutes of standing
- Symptoms that worsen when upright and improve when lying down
- No significant drop in blood pressure explaining the symptoms
Unlike many heart conditions, POTS does not usually involve structural heart disease. However, its symptoms often feel cardiac in nature, which understandably causes fear and confusion.
Are POTS Heart Disease?
This is one of the most searched patient questions—and for good reason.
POTS is not classified as heart disease, but it directly affects how the heart responds to changes in posture. The heart itself is typically structurally normal, yet it compensates excessively when blood pools in the lower body upon standing.
That compensation leads to:
- Rapid heartbeat
- Palpitations
- Chest discomfort
- Exercise intolerance
Cardiologists like Dr. Cynthia Thaik often explain to patients that POTS is more about miscommunication between the nervous system and the cardiovascular system, not damage to the heart muscle or arteries.
That said, careful cardiac evaluation is essential to rule out conditions that may overlap or mimic POTS symptoms.
Why POTS Is Often Misdiagnosed
POTS can be difficult to diagnose because its symptoms overlap with anxiety disorders, chronic fatigue syndrome, dehydration, and even hormonal imbalances.
Patients are frequently told:
- “Your tests are normal”
- “It’s just stress”
- “You’re dehydrated”
- “It’s anxiety-related”
While anxiety can coexist with POTS, it is not the root cause. The delay in diagnosis often leads to frustration and worsening symptoms.
Experienced clinicians recognize that diagnosing POTS requires listening carefully to the patient’s story, not just reviewing lab results.
How Doctors Diagnose POTS Syndrome
1. Detailed Medical History
Diagnosis begins with understanding symptom patterns:
- Do symptoms worsen after standing?
- Is there lightheadedness, fatigue, or palpitations?
- Are symptoms worse after meals, heat exposure, or exertion?
Doctors trained in autonomic disorders know these details matter.
2. Orthostatic Vital Signs
Heart rate and blood pressure are measured while lying down, sitting, and standing. A consistent rise in heart rate without a corresponding drop in blood pressure is a key diagnostic clue.
3. Tilt Table Testing
The tilt table test remains the gold standard for diagnosing POTS. The patient is positioned on a table that tilts upright while heart rate and blood pressure are continuously monitored.
This test helps confirm:
- Heart rate response
- Symptom reproduction
- Autonomic nervous system behavior
4. Cardiac Testing
To rule out heart disease or arrhythmias, doctors may order:
- Electrocardiogram (ECG)
- Echocardiogram
- Holter or event monitors
This is where expertise in rhythm disorders matters, especially when distinguishing POTS-related tachycardia from conditions like atrial fibrillation.
POTS and Heart Rhythm Concerns
Many patients worry their symptoms mean something more dangerous is happening with their heart rhythm.
While atrial fibrillation is not caused by POTS, palpitations from POTS can feel similar. That’s why cardiologists often evaluate for rhythm disorders before confirming a POTS diagnosis.
Atrial fibrillation treatments are very different from POTS management, which makes accurate diagnosis critical. Treating the wrong condition can worsen symptoms rather than improve them.
How Doctors Treat POTS Syndrome
There is no single cure for POTS, but there are effective treatment strategies. Most successful plans combine lifestyle adjustments with targeted medical therapy.
1. Lifestyle-Based Treatment (Foundational Care)
This is where most improvement begins.
Hydration and Salt Intake
Increasing fluids and sodium helps expand blood volume and reduce heart rate spikes.
Compression Garments
Compression stockings or abdominal binders reduce blood pooling in the legs.
Exercise Therapy
Gradual, structured exercise—starting with recumbent or seated activities—helps retrain the autonomic system over time.
Experienced physicians emphasize that exercise must be paced carefully to avoid symptom flares.
2. Medications (When Needed)
Medication is individualized and depends on symptom profile.
Common options include:
- Beta blockers to control heart rate
- Ivabradine for rate control without lowering blood pressure
- Fludrocortisone to increase blood volume
- Midodrine to improve vascular tone
Physicians like Dr. Cynthia Thaik stress that medication selection should never be “one-size-fits-all.” Careful monitoring and adjustment are essential.
3. Treating Underlying Triggers
POTS often overlaps with other conditions:
- Autoimmune disorders
- Mast cell activation
- Ehlers-Danlos syndrome
- Post-viral syndromes
Addressing these contributors can significantly improve outcomes.
Can POTS Get Better?
This is the question patients care about most.
For many, yes.
With consistent treatment, education, and support:
- Symptoms often improve over time
- Functional capacity increases
- Flares become less frequent
Recovery is not always linear. There are good weeks and harder weeks. But many patients eventually return to work, exercise, and normal daily routines.
The key is early diagnosis and expert-guided care.
Why Seeing the Right Specialist Matters
POTS sits at the crossroads of cardiology, neurology, and internal medicine. Physicians who understand autonomic disorders and complex heart rate patterns are better equipped to guide patients safely.
Dr. Cynthia Thaik is known for combining advanced cardiology expertise with a whole-person approach—an important balance for conditions like POTS that affect more than just the heart.
Living With POTS: Practical Patient Advice
Patients who do best often:
- Track symptoms and triggers
- Advocate for themselves during appointments
- Pace activities intentionally
- Prioritize sleep and stress management
Education empowers patients to recognize flares early and respond before symptoms escalate.
Final Thoughts
POTS syndrome is real, complex, and often misunderstood—but it is also manageable. While POTS is not heart disease, it requires thoughtful cardiovascular evaluation and care. With accurate diagnosis, individualized treatment, and guidance from experienced clinicians, patients can move from survival mode back to living fully.
If you or someone you love is struggling with unexplained dizziness, rapid heart rate, or fatigue, seeking care from a provider experienced in POTS and heart rhythm conditions may be the turning point.
