Symptoms

Orthostatic intolerance is a term that is sometimes used to describe symptoms of PoTS. It means symptoms that occur on standing and are relieved by lying down.

In addition to heart rate and blood pressure, other bodily functions that are regulated by the autonomic nervous system can be affected. 

Symptoms range from mild to severe and tend to be worse in the morning and vary from day to day.

Symptoms can include:

Palpitations

Palpitations are a sensation of your heart pounding in your chest. 

Dizziness or light-headedness or presyncope (almost fainting)

These symptoms usually occur when standing up but can occur with prolonged sitting. 

Syncope (fainting or blackouts)

Approximately 30-60% of people with PoTS also experience a condition called vasovagal fainting. Some people think that all patients with PoTS faint, but this is not correct.

Chest Pain

Chest pain is fairly common in patients and can be worse when upright. The cause is not clear.

Shortness of breath

Patients can feel breathless when standing up or with slight exertion. 

Shakiness or Tremulousness 

Excessive sweating

Gut problems 

Symptoms may include nausea, diarrhoea, constipation, bloating, abdominal pain and vomiting. Many people with PoTS are told that they have irritable bowel syndrome. 

Bladder problems 

Visual problems 

This can be described as excessive glare, blurred or tunnel vision.

“PoTS feet” (peripheral acrocyanosis)

Purple hands and feet affect around half of patients.

Tiredness or weakness

These are common symptoms of PoTS and can last for a considerable time after a bout of symptoms of PoTS.

Brain fog 

People with PoTS often complain of ‘brain fog’ which is difficulty in thinking or concentrating. Brain fog has been described as being “forgetful, difficulty thinking, difficulty focusing, cloudy, difficulty finding the right words or communicating. It may be triggered by fatigue, lack of sleep, prolonged standing, dehydration, and feeling faint. Although aggravated by upright posture, brain fog has been reported to persist after assuming a recumbent posture.

Headaches 

Approximately 30% of those with PoTS have orthostatic headaches which means they occur as a result of being upright and may be caused by reduced blood supply to the brain.  Many with PoTS also have migraine type headaches.

Exercise intolerance

Many people with PoTS experience severe worsening of symptoms after exercise, especially when this is undertaken in an upright position. It can take hours or sometimes days to recover.

Poor sleep 

Many patients with PoTS have problems with sleeping.  This may be trouble getting to sleep, waking in the middle of the night and trouble getting back to sleep. 

Symptoms may be worsened by:

Excess heat

After eating – especially refined carbohydrate e.g., sugar, food made from white flour

Speed of positional change – don’t stand up quickly

Dehydration

Time of day (may be worse in the morning, especially rising after wakening)

Menstrual period

Deconditioning or prolonged bed rest

Alcohol which dilates blood vessels

Exercise (an occasional bout of exercise can cause one to feel worse, but an ongoing exercise program may improve symptoms)