What Is POTS? A Nurse Explains Postural Orthostatic Tachycardia Syndrome

By Anna Curran, RN, BSN, PHN · Last reviewed October 2026

What is POTS? POTS, or postural orthostatic tachycardia syndrome, is a condition where your heart rate jumps much higher than normal when you go from lying down to standing up. It can cause dizziness, a racing heart, fatigue and fainting. It is real, it is more common than many people think, and most people improve over time with treatment.

If you have been told “it’s just anxiety” or “you’re dehydrated” for years, this article is for you. Here is what is going on in your body and what the research says.

What Is POTS and How Does It Work?

To understand POTS, it helps to know a little about your autonomic nervous system. This is the part of your nervous system that runs on autopilot. It controls things you don’t think about, like your heart rate, blood pressure, digestion, sweating and body temperature.

When anyone stands up, gravity pulls blood down toward the legs and belly. In a healthy body, the autonomic nervous system reacts within seconds. Blood vessels tighten, and the heart speeds up a little to keep blood flowing to the brain.

According to Mayo Clinic, a normal resting heart rate is about 70 to 80 beats per minute, and it usually rises by 10 to 15 beats when you stand. In POTS, it often rises 30 to 50 beats or more.

With POTS, that balancing system does not work the way it should. Mayo Clinic describes the blood vessels as “too relaxed.” Too much blood stays in the lower body, and not enough returns to the heart. The heart races to make up for it. Even so, your brain may not get quite enough blood flow, which is why you feel lightheaded, foggy or faint.

The Heart Rate Rise on Standing

The “postural” part of the name means position. “Orthostatic” means standing upright. “Tachycardia” means a fast heart rate.

The National Institute of Neurological Disorders and Stroke (NINDS) describes POTS as a heart rate increase of more than 30 beats per minute, or a heart rate over 120, within 10 minutes of standing. For teens, Mayo Clinic and Dysautonomia International note a higher cutoff: a rise of at least 40 beats per minute.

One important detail: in POTS, blood pressure usually does not drop much when you stand. That helps doctors tell it apart from orthostatic hypotension, a different problem where blood pressure falls sharply.

Types of POTS

POTS is called a syndrome because it is a group of symptoms that can have different causes. Cleveland Clinic describes a few main types. Some people have features of more than one.

Neuropathic POTS: The small nerves that tighten blood vessels, especially in the legs and core, don’t work well. Blood pools in the lower body.
Hyperadrenergic POTS: The “fight-or-flight” side of the nervous system is overactive. People may feel shaky, sweaty or anxious-feeling when upright.
Hypovolemic POTS: The body has less blood volume than usual.

When no clear cause is found, it is sometimes called primary or idiopathic POTS.

Who Gets POTS?

Anyone can get POTS at any age. Still, it shows up most often in certain groups.

NINDS reports that 75 to 80 percent of people with POTS are women between 15 and 50 years old.
Mayo Clinic notes that it often starts in the teen or early adult years.
Some women notice symptoms get worse around their menstrual period.
Having a biological family member with POTS raises your risk, according to Cleveland Clinic.

How many people have it? Estimates vary. Cleveland Clinic says POTS affects more than 500,000 people in the United States. Dysautonomia International, a patient group, estimates it affected 1 to 3 million Americans before COVID-19, with experts believing the number has grown since.

Common Triggers: What Can Start POTS?

Researchers are still learning what causes POTS. Many people can point to a time when their symptoms began. NINDS and Cleveland Clinic list these common starting points:

A viral illness, such as mononucleosis
COVID-19
Pregnancy
Major surgery
Physical trauma, such as a head injury

There is also growing evidence that some cases may be autoimmune, meaning the immune system may play a role.

POTS after COVID-19

Many people developed POTS-like symptoms after COVID-19. Long COVID can affect the autonomic nervous system, causing a racing heart on standing, lightheadedness and fatigue. The National Institutes of Health (NIH) launched clinical trials through its RECOVER program to test treatments for POTS in people with long COVID. If your symptoms started after COVID, tell your doctor. It is a recognized link, not something you imagined.

Related Conditions

POTS often shows up alongside other health problems. This does not mean you have them, but it is worth knowing about them.

Ehlers-Danlos syndrome (EDS): A group of connective tissue conditions. Cleveland Clinic lists hypermobile EDS (very flexible joints) as a risk factor for POTS.
Mast cell activation disorders (MCAS): Mast cells are immune cells that release chemicals like histamine. When they overreact, they can cause flushing, hives, stomach upset and other symptoms. Dysautonomia International lists mast cell disorders among conditions linked with POTS. Researchers have noticed that POTS, hypermobile EDS and MCAS often appear together, though how they connect is still being studied.
Autoimmune conditions: Sjögren’s syndrome, lupus and celiac disease are linked with POTS.
Other conditions: Diabetes, vitamin deficiencies, anemia and some infections, such as Lyme disease, can be associated with POTS.

If you have POTS along with joint pain, easy bruising, frequent allergic-type reactions or dry eyes and mouth, mention these to your doctor. They may want to look into related conditions.

Is POTS Caused by Anxiety?

No. POTS is a physical problem with how your body controls heart rate and blood flow. Dysautonomia International notes that people with POTS are no more likely than the general public to have an anxiety or panic disorder.

The confusion makes sense. A racing heart, shakiness and shortness of breath can feel like panic. But these symptoms in POTS are tied to being upright, and they usually ease when you lie down. Living with a chronic condition can be stressful, and caring for your emotional health matters too. But stress is not the root cause.

What Is the Outlook for POTS?

The outlook is generally good. Cleveland Clinic states that people with POTS have a normal life expectancy.

NINDS and Mayo Clinic both report that about 80 percent of people with POTS improve over time, though many keep some milder symptoms.
POTS often comes and goes. You may have good stretches and harder stretches over the years.
Teens, in particular, may see their symptoms ease as they get older.

That said, POTS can be very disruptive. Dysautonomia International reports that about 25 percent of people with POTS are unable to work. Some people keep working, going to school and socializing, while others are much more limited. The biggest physical danger, according to Cleveland Clinic, is getting hurt from a fall after fainting.

Treatment can make a real difference. Most plans start with fluids, salt (if your doctor approves), compression garments and a gradual exercise program. Some people also need medicine. You can learn more in our guides to POTS symptoms and diagnosis, POTS treatment and living with POTS.

Frequently Asked Questions

Is POTS a heart disease?

Not exactly. Your heart itself is usually healthy in POTS. The problem is with the nervous system signals that control heart rate and blood vessels. The fast heart rate is the heart responding to less blood returning from the lower body.

Can men get POTS?

Yes. Most people with POTS are women, but men and boys can have it too. It can affect people of any age, sex or race.

Is POTS permanent?

For most people, it is not. About 80 percent of people improve over time, though some symptoms may linger. Working with a doctor who knows POTS can help you feel better sooner.

Can COVID-19 cause POTS?

COVID-19 is a recognized trigger for POTS, much like other viral illnesses. If your symptoms started after a COVID-19 infection, let your doctor know so they can consider POTS.

The Bottom Line

POTS is a condition where your heart rate rises too much when you stand, because your autonomic nervous system doesn’t manage blood flow well. It is most common in women ages 15 to 50 and often starts after a viral illness, COVID-19, pregnancy, surgery or injury. It is not caused by anxiety. Most people improve over time, especially with a treatment plan built with a doctor who understands POTS.