Symptoms Of POTS

Symptoms present in various degrees of severity depending on the patient. POTS can be severely debilitating. Some patients are unable to attend school or work, and especially severe cases can completely incapacitate the patient.

Symptoms

The hallmark symptom of POTS is an increase in heart rate from the supine to upright position of more than 30 beats per minute or to a heart rate greater than 120 beats per minute within 12 minutes of head-up tilt.
This tachycardic response is sometimes accompanied by a decrease in blood pressure and a wide variety of symptoms associated with hypotension. Low blood pressure of any kind may promote the following:^[3]

• lightheadedness, sometimes called pre-syncope (pre-fainting) dizziness (but not vertigo, which is also called dizziness)^[4]
• exercise intolerance
• extreme fatigue
• syncope (fainting)
• Excessive thirst (polydipsia)

Chronic or acute hypoperfusion of tissues and organs in the upper parts of the body are thought to cause the following symptoms:

• cold extremities
• chest pain and discomfort
• disorientation
• tinnitus
• dyspnea
• headache
• muscle weakness
• tremulousness
• visual disturbances

Autonomic dysfunction is thought to cause additional gastrointestinal symptoms:

• abdominal pain or discomfort
• bloating^[5]
• constipation
• diarrhea
• nausea
• vomiting

Cerebral hypoperfusion, when present, can cause cognitive and emotive difficulties. Symptoms that persist in the supine (recumbent) state are difficult to attribute to "cerebral hypoperfusion"

• brain fog
• burnout
• decreased mental stamina
• depression
• difficulty finding the right word
• impaired concentration
• sleep disorders

Inappropriate levels of epinephrine and norepinephrine lead to anxiety-like symptoms:

• chills
• feelings of fear
• flushing
• overheating
• nervousness
• over-stimulation

Symptoms of POTS overlap considerably with those of generalized anxiety disorder, and a misdiagnosis of an anxiety disorder is not uncommon.