What is POTS

Postural Orthostatic Tachycardia Syndrome (POTS) is a form of autonomic nervous system dysfunction. The condition is characterised by orthostatic intolerance and an excessive increase in heart rate upon standing in the absence of orthostatic hypotension. The syndrome disproportionately affects females (approx. 85%) and often begins in adolescence or early adulthood. Many experience a delay in diagnosis due to symptom overlap with other complex disorders. Early recognition and management can reduce disruption to education, work, and social development.

New Patient Brochure

Our New Patient Brochure provides a concise, evidence-based introduction to POTS, including key management tips and support resources for newly diagnosed individuals.

For a small annual fee, patients, carers, and clinicians can become members of the Australian POTS Foundation, gaining access to member-only benefits including discounts on hydration products, compression wear, and more. Follow this link to find out more about membership.

When to Suspect POTS?

Diagnosing POTS can be challenging in general practice due to its wide range of symptoms and overlap with other conditions. Women, who represent the majority of those affected, face especially long diagnostic delays, with their symptoms frequently misattributed to anxiety or depression, further delaying appropriate care.

Primary care physicians are uniquely positioned to change this. By considering POTS early in your diagnostic process, you can help reduce delays, improve patient outcomes, and alleviate the significant burden this condition places on individuals and the healthcare system.

This guide provides practical tools and strategies to help you identify and manage POTS with confidence, ensuring your patients receive timely and effective care. Together, we can improve the lives of those living with this often-overlooked condition.

Precipitating Triggers

Postural Orthostatic Tachycardia Syndrome (POTS) is often triggered by a significant physiological or neurological stressor. Common initiating events include viral or bacterial infections, concussion, major surgery, and periods of hormonal change such as menarche, pregnancy, or menopause. Less frequently, prolonged psychological stress or trauma may also contribute to the onset of autonomic dysfunction.

More than one-third of POTS presentations are attributed to a viral insult, with COVID-19 now recognised as a significant and growing precipitant. Individuals with underlying conditions such as heritable connective tissue disorders or immune dysregulation are particularly vulnerable to developing POTS following any of these triggers.

Symptoms

Begin the diagnostic process by obtaining a comprehensive medical history from the patient. Pay close attention to symptoms suggestive of autonomic dysfunction, including:

  • Dizziness/light-headedness
  • Postural tachycardia
  • Headache
  • Pre-syncope/syncope
  • Palpitations
  • Fatigue
  • Exercise intolerance

  • Nausea
  • Early satiety
  • Decreased appetite/weight loss
  • Bloating
  • Constipation
  • Reflux [in the setting of young age and normal weight]

  • Heat and cold intolerance
  • Excessive sweating lack of sweating
  • Dry eyes/mouth

  • Hesitancy/retention
  • Urgency/frequency

  • Facial flushing
  • Dependent acrocyanosis [purple/red colouring of peripheries during orthostasis]

  • Brain fog
  • Pain syndromes
  • Post exertional malaise

Related Conditions

POTS is rarely an isolated diagnosis. It frequently presents alongside a cluster of multisystem disorders that can obscure recognition and complicate management. Awareness of these associations is essential for improving diagnostic accuracy, tailoring treatment plans, and delivering whole-of-body care to affected individuals. These conditions include:

Anxiety and POTS

Symptoms of anxiety can closely resemble those of POTS, which puts individuals with POTS at risk of being misdiagnosed with anxiety. Since many anxiety surveys rely heavily on somatic symptoms—common in POTS—this may overestimate anxiety prevalence in this group.

To help distinguish anxiety from POTS, it is important to assess cognitive symptoms of anxiety (such as worry and racing thoughts) and differentiate them from postural responses (like tachycardia, palpitations, and tremulousness), rather than relying solely on somatic symptoms.

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