Understanding POTS: What It Is, Why It Happens, and What Can Help
If you’ve ever stood up and felt your heart explode into a sprint—along with dizziness, brain fog, shakiness, shortness of breath, or a “crash” feeling—you’re not alone. One possible explanation is POTS, short for Postural Orthostatic Tachycardia Syndrome.
POTS can be confusing because symptoms often look like “anxiety,” “deconditioning,” or “just stress,” yet many people are dealing with a real physiologic pattern involving blood flow, heart rate, and the autonomic nervous system. This post is a clear, practical overview of what POTS is, how it’s diagnosed, and what tends to help.
Quick note: This article is educational and not medical advice. If you suspect POTS, the best next step is a proper evaluation with a qualified clinician (often primary care, cardiology, neurology, or a dysautonomia-focused clinic).
What is POTS?
POTS is a form of dysautonomia (autonomic nervous system dysfunction) characterized by a significant rise in heart rate when moving from lying down to standing, along with symptoms of orthostatic intolerance (symptoms that worsen upright and improve when you sit or lie down).
A commonly used adult criterion is:
Heart rate increases by ≥30 beats per minute within 10 minutes of standing (or tilt-table testing)
Without orthostatic hypotension (a large blood pressure drop)
For adolescents (roughly ages 12–19), the threshold is often ≥40 bpm.
What does POTS feel like?
People experience POTS differently, but common symptoms include:
Lightheadedness, dizziness, or feeling faint when upright
Rapid heartbeat / palpitations when standing
Fatigue and post-exertional “crashes”
Brain fog, trouble concentrating
Tremor/shakiness, anxiety-like sensations
Exercise intolerance
Headaches, nausea, GI upset, temperature sensitivity
Symptoms often worsen with:
Heat
Dehydration
Long periods of standing
Illness / viral infections
Poor sleep
Why does POTS happen?
POTS is not one single cause—it’s a pattern that can involve multiple mechanisms, such as:
Low blood volume (hypovolemia) or poor fluid regulation
Blood pooling in the legs/abdomen when standing
Excess sympathetic activation (“fight-or-flight” stuck on high)
Deconditioning (often a consequence, not a character flaw)
Sometimes autoimmune associations or overlap with other conditions
You may also see POTS discussed alongside:
Long COVID (a recognized post-viral context for dysautonomia symptoms)
Hypermobility syndromes (like EDS), migraine, MCAS-like symptoms (complex and individualized)
How is POTS diagnosed?
A clinician typically uses:
History (symptoms that worsen upright and improve with lying down)
Orthostatic vitals (heart rate + blood pressure changes lying → standing)
Sometimes tilt-table testing
POTS is generally diagnosed only when other explanations are addressed—particularly orthostatic hypotension, dehydration, or blood loss.
A simple at-home screen (not a diagnosis)
Some people do a basic “poor man’s tilt test” at home:
Rest lying down for ~5–10 minutes, measure HR/BP
Stand and measure HR/BP at 1, 3, 5, and up to 10 minutes
If your heart rate jumps dramatically and symptoms flare, that can be a clue—but a clinician should interpret it, especially if you’re on medications or have cardiac history.
What tends to help POTS symptoms?
There’s no single cure and treatment is individualized, but many guidelines emphasize starting with foundational, non-pharmacologic strategies.
1) Fluids + electrolytes (guided by your clinician)
Many patients do better with higher fluid intake, and sometimes increased sodium—but this must be personalized(especially with hypertension, kidney disease, or other contraindications).
2) Compression garments
Compression (often waist-high or abdominal + legs) can reduce blood pooling when upright.
3) Exercise, but the right kind
Graded programs often begin with recumbent or seated training (bike, rowing, swimming) and gradually build tolerance over time.
4) Sleep, meals, and heat strategies
Smaller, more frequent meals can reduce post-meal symptoms for some
Heat avoidance, cooling strategies, pacing, and structured rest can matter a lot
5) Medications (when appropriate)
Some people benefit from medications (for example, certain beta-blockers or other autonomic-support meds), but that’s a conversation for your medical provider.
When to seek urgent medical care
Get urgent evaluation if you have:
Chest pain, fainting with injury, severe shortness of breath
New neurologic symptoms (weakness, trouble speaking, vision loss)
Rapid heart rhythm that feels sustained/irregular
Severe dehydration or inability to keep fluids down
Where does upper cervical care fit in?
POTS is primarily a medical/autonomic condition, so we don’t present chiropractic as a “POTS cure.” What we can do is support the inputs that influence autonomic regulation and balance, especially when neck dysfunction, dizziness, headaches, or posture-related symptoms are part of the picture.
At Upper Cervical Chiropractic Encinitas, our role is often supportive and collaborative:
Assess neck mechanics + nervous system stressors (posture, range of motion, muscle tone, symptom triggers)
Objective balance and proprioception testing (when relevant)
Gentle, specific upper cervical corrections when indicated (no twisting/cracking)
Coordinate care: if your presentation suggests POTS (or something that looks like it), we encourage proper medical evaluation and can work alongside your primary care/cardiology/neurology team
Many people with orthostatic intolerance also report symptoms like dizziness, brain fog, neck tension, and headaches—so improving cervical function and sensorimotor control may be a helpful piece of the overall puzzle for the right person. The key is matching the approach to the individual, and keeping expectations realistic.
FAQ
Is POTS “just anxiety”?
POTS can feel like anxiety (racing heart, shakiness), but it’s defined by a postural physiologic change in heart rate and symptoms when upright.
Can POTS improve?
Many people improve with a combination of education, lifestyle changes, rehab-style conditioning, and (when needed) medications—though timelines vary.
Who treats POTS?
Often primary care coordinates, with cardiology, neurology, and rehab/physical therapy involved. Some regions have dedicated dysautonomia/POTS programs.
Next step (Encinitas / North County San Diego)
If you’re dealing with dizziness, fatigue, brain fog, headaches, or symptoms that flare when upright—and you want an objective, calm, step-by-step plan—our office can help you rule in/out neck-related contributors and build a supportive plan while you pursue appropriate medical evaluation.
Call or book online (and if you already have a POTS diagnosis, tell us what testing you’ve done and what triggers your symptoms most).
References :
Heart Rhythm Society (2015) Expert Consensus Statement (PMC full text):
https://pmc.ncbi.nlm.nih.gov/articles/PMC5267948/
NINDS (NIH) POTS overview (updated Dec 29, 2025):
https://www.ninds.nih.gov/health-information/disorders/postural-tachycardia-syndrome-pots
Johns Hopkins Medicine: POTS overview:
https://www.hopkinsmedicine.org/health/conditions-and-diseases/postural-orthostatic-tachycardia-syndrome-pots
Cleveland Clinic: POTS overview:
https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots
Cleveland Clinic Journal of Medicine (2019): Evaluating and managing POTS:
https://www.ccjm.org/content/86/5/333
Canadian Cardiovascular Society Position Statement (2020):
https://onlinecjc.ca/article/S0828-282X%2819%2931550-8/fulltext
