POTS 101

For most people, standing up is a natural and effortless part of daily life. But for people affected by a disorder called postural orthostatic tachycardia syndrome (POTS), the simple act of standing can provoke lightheadedness and a racing heartbeat. Postural Orthostatic Tachycardia Syndrome (POTS) is a complex condition that affects millions of people worldwide. It is estimated that POTS affected approximately 3 million Americans before COVID-19. Recent research shows that the number of POTS patients is now estimated to impact at least 6 million Americans since the pandemic began. While anyone can develop POTS, approximately 75% of those diagnosed are women between the ages of 15 and 50. POTS can be triggered by a variety of life stressors including pregnancy, major surgery, trauma, or a viral infection like mononucleosis, Lyme disease, or COVID-19. 

POTS is a type of dysautonomia, which means that the autonomic nervous system, responsible for controlling vital functions such as heart rate, blood pressure, and breathing, does not function properly. As a holistic cardiologist practicing in Los Angeles, Dr. Cynthia Thaik, MD and the staff at Holistic Healing Heart Center have seen many patients with POTS. We believe in taking a whole-body approach to evaluating POTS patients and helping patients achieve optimal health and wellness.

What is POTS?

Postural orthostatic tachycardia syndrome (POTS) is one of a group of disorders that have orthostatic intolerance (OI) as their primary symptom. OI is a condition in which an excessively reduced volume of blood returns to the heart after an individual stands up from a lying down position. Normally, when you stand up, your blood vessels tighten to help pump blood to your brain and other organs. But in people with OI, this doesn’t happen properly, and blood may not reach the brain as efficiently, causing a range of symptoms. Some of the most common symptoms of OI include dizziness, lightheadedness, fatigue, brain fog, palpitations, and sometimes even fainting. OI can be caused by a variety of factors, such as dehydration, low blood pressure, nervous system disorders, and certain medications.

Let’s review the definition of POTS. Each word of “postural orthostatic tachycardia syndrome” has a meaning:

🟣Postural: Related to the position of your body. In POTS, symptoms are often triggered by changes in position, such as standing up.

🟣Orthostatic: Related to standing upright. People with POTS often experience symptoms related to standing or sitting up for long periods of time.

🟣Tachycardia: A heart rate over 100 beats per minute. In POTS, the heart rate may increase excessively and rapidly upon standing or changing positions.

🟣Syndrome: A group of symptoms that happen together. POTS is a syndrome that includes a range of symptoms related to the cardiovascular and nervous systems, including rapid heartbeat, lightheadedness, fatigue, and other symptoms that can significantly impact the quality of life.

Postural orthostatic tachycardia syndrome (POTS) is a blood circulation disorder characterized by two factors:

🟣A specific group of symptoms that frequently occur when standing upright

🟣A heart rate increase from horizontal to standing (or as tested on a tilt table) of at least 30 beats per minute in adults, or at least 40 beats per minute in adolescents, measured during the first 10 minutes of standing

Whom Does POTS Affect?

The majority of people with POTS are women and people assigned female at birth aged 15 to 50 years. But men and people assigned male at birth can also have POTS.

You’re at a higher risk of developing POTS after experiencing the following stressors:

🟣Significant illnesses, such as viral illnesses like mononucleosis or severe infections.


🟣Physical trauma, such as a head injury.


🟣People who have certain autoimmune conditions, such as Sjogren’s syndrome, lupus and celiac disease, are also more likely to develop POTS.

Researchers don’t fully understand the causes of POTS, but it is more common in women than men and is more likely to develop in adolescents and young adults.

There is new evidence that COVID-19 may trigger POTS, according to data on nearly 300,000 patients from the Cedars-Sinai Health System in Los Angeles County from 2020 to 2022 who had either received at least one dose of a COVID vaccine or had a confirmed case of COVID. While the researchers found a small but increased risk of POTS following COVID vaccination and, in particular, the first dose, the risk was greater following a COVID infection itself: Getting COVID-19 was linked to a five times greater risk of POTS than vaccination.

History of POTS

The term “POTS” was coined in 1993 by a team of researchers from Mayo Clinic, led by neurologist Dr. Philip Low. However, POTS is not a new illness; it has been known by other names throughout history, such as DaCosta’s Syndrome, Soldier’s Heart, Mitral Valve Prolapse Syndrome, Neurocirculatory Asthenia, Chronic Orthostatic Intolerance, Orthostatic Tachycardia and Postural Tachycardia Syndrome. 

There is some evidence to suggest that POTS and anxiety can be related, as both conditions can involve similar symptoms such as palpitations, dizziness, and shortness of breath.

What are the symptoms of POTS?

You can develop POTS suddenly or it can develop gradually. The classification of POTS is the subject of discussion, but most authorities recognize different characteristics in POTS, which occur in some patients more than others.

Symptoms happen immediately or a few minutes after sitting up or standing. Lying down may relieve some of the symptoms.

POTS has several possible symptoms, and they vary from person to person. Symptoms include:

🟣Dizziness or lightheadedness, especially when standing up, during prolonged standing in one position or on long walks.

🟣Fainting or near fainting.

🟣Forgetfulness and trouble focusing (brain fog).

🟣Heart palpitations or racing heart rate.


🟣Feeling nervous or anxious.

🟣Shakiness and excessive sweating.

🟣Shortness of breath (dyspnea).

🟣Chest pain.


🟣Feeling sick.


🟣A pale face and purple discoloration of your hands and feet if they’re lower than the level of your heart.

🟣Disrupted sleep from chest pain, racing heart rate and excessive sweating during sleep.

POTS symptoms often get worse in the following situations:

🟣Being in warm environments, such as in a hot bath or shower or on a hot day.

🟣Standing frequently, such as when you’re waiting in line or shopping.

🟣Participating in strenuous exercise.

🟣When you’re sick, such as from a cold or an infection.

🟣Having your period (menstruation).

Although the origin of POTS symptoms is physical, sometimes people attribute the symptoms incorrectly to psychological disorders such as anxiety. While some people with POTS have anxiety disorders similar to the general population, POTS is not caused by anxiety.

How Is POTS Diagnosed?

Diagnosis of POTS will generally begin with the physician taking a medical history and performing a physical exam. During the physical exam, the physician may perform a tilt table study to evaluate the heart and blood pressure when the body changes positions. Based on the tilt table test and the patient’s symptoms, an accurate diagnosis can often be made.

In some instances, the physician may order additional tests to rule out other conditions. These diagnostic tests may examine the heart muscle, the blood flow through the heart, and any potential abnormal electrical impulses. An electrocardiogram (EKG) is a painless procedure that provides a picture of the electrical activity of the heart and how the heart is working.

Another diagnostic tool that could be used is an echocardiogram. This non-invasive procedure uses a machine called a transducer that transmits sound waves and bounces them off the heart and back into the transducer. 

Electrophysiology studies may also be used to look at the electrical system of the heart.

Your provider may order other tests to help confirm a POTS diagnosis or rule out other possible causes of your symptoms, including:

🟣Blood and urine tests for causes of POTS and conditions that mimic POTS.

🟣QSART (a test that measures the autonomic nerves that control sweating).

🟣Autonomic breathing test (this measures your blood rate and pressure response during exercise).

🟣TST (tuberculin skin test).

🟣Skin nerve biopsy.


🟣Blood volume with hemodynamic studies.

Treatment for POTS

Healthcare providers use several strategies to manage the symptoms of POTS. Treatment is highly individualized based on your symptoms and what works best for you.

The main forms of treatment include:

🟣Exercise and physical activity. Studies show that reclined aerobic exercise, such as swimming, rowing and recumbent bicycling, has the best results. Strengthening your core and leg muscles is also helpful.

🟣Diet and nutrition. If you have the hypovolemic (low blood volume) form of POTS, your healthcare provider will likely recommend increasing both your fluid and salt intake to increase blood volume. Eating a large meal can make symptoms of POTS worse, as your body redirects a lot of blood to aid in the digestion process. Because of this, providers often recommend eating several smaller meals throughout the day instead of two or three large ones.

Medical compression stockings can also help push blood up from your legs to reduce POTS symptoms. They may also give you more endurance to tolerate longer amounts of upright activity before your dysautonomia symptoms set in.

Postural Orthostatic Tachycardia Syndrome (POTS) can be a challenging and debilitating condition for those who experience it. However, it is important to be hopeful and recognize that there are treatment options available that can greatly improve quality of life.

With proper diagnosis and treatment, many people with POTS are able to manage their symptoms and live fulfilling lives. This can include lifestyle changes such as increasing fluid and salt intake, exercise, and medications such as beta blockers or midodrine.

Patients with POTS Find Support At The Holistic Healing Heart Center In Los Angeles

Dr. Cynthia Thaik, MD, one of the top doctors in Los Angeles, is a Harvard-trained, holistic cardiologist who practices with her heart. She helps replace stress, fear, and anxiety in patients by instilling a sense of inner calm and peace. She educates and inspires clients to take proactive steps toward health and healing. Her team has helped thousands of people transform their lives through the ways they think, feel, and act.

Uniting Eastern and Western practices, naturopathic cardiologist Dr. Cynthia Thaik, MD and her staff have made it their objective to keep their patients’ hearts healthy and vibrant – in its truest definition. Sometimes the road to health means changing long-held habits, but Dr. Cynthia and her team greet such challenges with compassion and focus. Their motto is, “If you’re willing to commit to a healthier life, then we are here to help you”.

Dr. Cynthia’s practice at the Holistic Healing Heart Center in Los Angeles offers cardiovascular consultation, stress (ischemia) evaluation, risk factor assessment and treatment, primary care services, weight loss and nutritional counseling, and stress reduction methods including hypnotherapy, guided meditation, and Reiki or energy healing. In short, Dr. Cynthia blends the best of both Western and Eastern medicine to tackle coronary artery disease, and cardiovascular disease, and reduce a patient’s risk of heart attack. Holistic heart care is a matter of addressing the individual’s condition in a way that will facilitate not only recovery but also growth and development, so that the problem is unlikely to return because the individual’s general health has improved. This heart disease preventing philosophy is one which empowers patients to take control of their own health outcomes.

If you have been diagnosed with POTS or are experiencing symptoms similar to those in patients with POTS, schedule a consultation today as the first step to taking control of your cardiovascular health.