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Health condition

Postural tachycardia syndrome (PoTS)

PoTS is an abnormal rise in heart rate on standing - at least 30 bpm - with symptoms such as dizziness, palpitations, fatigue and brain fog. It mainly affects younger women and is very treatable.

Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against current NHS and UK specialist society guidance at the time of review.

  • 03

    Current for 2026

    Reviewed on 2026-09-27 with the next review scheduled for 2027-09-27.

Key facts

The essentials at a glance.

The symptoms to recognise, when to seek help, which specialist to see, and what treatment usually involves.

  • Typical symptoms: racing heart, light-headedness, brain fog, fatigue, shakiness and nausea on standing, relieved by lying down

  • Seek assessment for blackouts, or symptoms following an infection, to establish the diagnosis rather than living undiagnosed - PoTS averages years to diagnosis

  • Specialist: a consultant cardiologist usually leads assessment and treatment

  • Treatment combines fluid (2-3 litres) and salt increases, compression garments, structured reclined exercise, and medication such as ivabradine, beta-blockers or midodrine when needed

Understanding the condition

What it is and what happens next.

What causes it, how it is diagnosed, and the treatment routes available in the UK.

What it is and how it feels

In PoTS the heart rate leaps on standing - often past 120 bpm - because blood pools in the legs and abdomen and the nervous system compensates with heart rate instead of vessel tone. It commonly follows viral infections (including COVID), affects predominantly women aged 15-50, and overlaps with joint hypermobility and fatigue conditions. Blood pressure typically stays normal, distinguishing it from postural hypotension.

Diagnosis and treatment routes

Diagnosis uses an active stand test or tilt-table testing, measuring heart rate and blood pressure over 10 minutes upright. Management is genuinely effective: most people improve substantially with the fluid-salt-compression-exercise programme, and a cardiologist experienced in PoTS can add targeted medication for those who need more. In many parts of the UK, routine NHS referrals for this kind of problem currently take 20-45+ weeks, whereas an initial appointment with a private consultant is typically available within around two weeks.

Seeing a specialist

Who to see, and how quickly you can be seen.

The specialist for this condition is usually a consultant cardiologist. Your GP can refer you on the NHS, or you can arrange a private consultation directly.

A quiet reminder

This guide is for information, not medical advice.

Your GP knows your history and can tell you which parts apply to you. If in doubt, see them - and seek urgent care for any of the emergency symptoms described above.

Frequently asked

Common questions about Postural tachycardia syndrome (PoTS).

Quick, plain-English answers to what people ask us most.

  • What is postural tachycardia syndrome (POTS)?

    POTS is a condition affecting the autonomic nervous system, causing an excessive increase in heart rate upon standing, along with symptoms such as dizziness, fatigue, and palpitations.

  • What causes POTS?

    The exact cause often isn't clear, but it can develop after a viral infection, during or after pregnancy, following significant physical trauma, or alongside other conditions such as joint hypermobility syndromes or autoimmune disease.

  • What are the symptoms of POTS?

    A racing heart on standing, dizziness or lightheadedness, fatigue, brain fog, exercise intolerance, and sometimes fainting are common, typically worse on standing and improving when lying down.

  • Is POTS dangerous?

    POTS itself isn't typically life-threatening, but it can significantly affect quality of life and daily functioning, and the risk of fainting can lead to injury, so appropriate management is important.

  • Is POTS hereditary?

    There can be a genetic predisposition, particularly in POTS linked to joint hypermobility conditions, which often run in families, though many cases occur without a clear family history.

  • Can POTS be treated?

    Yes, treatment includes increased fluid and salt intake, compression garments, a specific graded exercise programme, and, for persistent symptoms, medications to help manage heart rate and blood pressure regulation.

  • How is POTS diagnosed?

    Diagnosis involves measuring heart rate and blood pressure changes on standing, often with a formal tilt table test, alongside a detailed symptom history and ruling out other causes of similar symptoms.

  • How long does POTS last?

    Many people, particularly those who develop POTS after a viral infection, see gradual improvement over one to several years, though for some the condition is more persistent and needs ongoing long-term management.

  • POTS vs simple postural hypotension — what's the difference?

    Postural hypotension involves a drop in blood pressure on standing, whereas POTS involves an excessive rise in heart rate, often without a significant blood pressure drop; both cause similar dizziness symptoms but are distinguished by specific standing or tilt table testing.

  • When should I see a specialist, and how quickly can I be seen privately?

    See a cardiologist or specialist clinic if you have symptoms suggestive of POTS. Private specialist assessment is typically available within about two weeks, considerably faster than standard NHS referral pathways for this condition.