# POTS Symptoms, Causes & Tests | OSANG Neurosurgery > Learn about POTS symptoms such as a racing heart, dizziness, and brain fog after standing, along with differential assessment, tilt-table testing, and HRV testing. - Official page: https://osns.co.kr/en/autonomic/pots/ - Organization: OSANG Neurosurgery ## Page content ## Autonomic Clinic ## If your heart beats wildly every time you stand up,Could it be postural orthostatic tachycardia syndrome (POTS)? Postural tachycardia syndrome (POTS) is an autonomic dysfunction in which the heart rate increases abnormally when standing up, causing dizziness, palpitations, brain fog, and chronic fatigue. It is characterized by an increase in heart rate of more than 30 beats per minute even though blood pressure does not drop significantly. Increased by more than 30 times per minute for adults ## What is orthostatic tachycardia syndrome (POTS)? Postural orthostatic tachycardia syndrome, POTS) within 10 minutes after standing up Heart rate increases more than 30 beats per minute(40 or more times for teenagers aged 12 to 19) Not accompanied by orthostatic hypotension It is a chronic autonomic dysfunction. According to the 2015 American Heart Rhythm Society expert consensus statement, POTS is diagnosed when the heart rate increases by more than 30 beats per minute within 10 minutes of standing up for adults, or when the absolute heart rate exceeds 120 beats per minute and systolic blood pressure does not fall by more than 20 mmHg. POTS is not a single disease, but involves multiple pathophysiological mechanisms, including neuropathic, hyperadrenergic, hypovolemic, autoimmune, and post-infectious. syndromeIn one patient, multiple mechanisms may overlap. It is estimated that approximately 1 to 3 million people in the United States have POTS, and approximately 80% of patients are women of childbearing age between the ages of 15 and 50, with a female-to-male ratio of approximately 5:1. ## What symptoms do you experience? Palpitations and dizziness when standing up are the key symptoms, and dysregulation of the overall autonomic nervous system, such as brain fog, chronic fatigue, digestive symptoms, and sweating abnormalities, also appear. It is characterized by relief when lying down and worsening when standing up. ### Palpitations and excessive tachycardia when standing up ### Dizziness, pre-syncope symptoms, brain fog ### Chronic fatigue and exercise intolerance ### digestive symptoms ### Abnormal sweating, discoloration of limbs, etc. ## Why does it happen? POTS is a syndrome that does not have a single cause but involves multiple pathophysiological mechanisms. It is divided into subtypes depending on which mechanism is dominant, and the treatment direction also varies. ### POTS (Neuropathic) ### Hyperadrenergic POTS (Hyperadrenergic) ### POTS (Hypovolemic) ### Autoimmune POTS (Autoimmune) ### Post-infectious (POTS) ## How is it diagnosed? The diagnosis of POTS is based on a combination of clinical symptoms, hemodynamic response upon standing, and exclusion of other diseases. The standard test is the standing incline table test (tilt test), and the subtype is differentiated by measuring heart rate variability (HRV) and blood catecholamines. Standard diagnostic tests are Standing tilt table test (tilt test)It is. The patient is laid down on the examination table and rested for 5 to 10 minutes, then tilted to an angle of 60 to 70 degrees. POTS is diagnosed if the heart rate increases by more than 30 beats per minute (more than 40 beats per minute for those aged 12 to 19) within 10 minutes after standing up, or if the absolute heart rate exceeds 120 beats and the systolic blood pressure does not fall by more than 20 mmHg. In outpatient clinics, blood pressure and heart rate are measured at 1, 3, 5, and 10 minutes after standing up. active standing testis implemented for screening purposes. To evaluate the sympathetic-parasympathetic balance of the autonomic nervous system Heart rate variability (HRV) analysisis used to confirm increased sympathetic nerve activity and decreased parasympathetic nerve function at rest in POTS patients and to monitor treatment effects. Standing position for subtype differentiation Measurement of blood catecholamines (norepinephrine)(Above 600 pg/mL suggests hyperadrenergic function). If autoimmunity is suspected, antinuclear antibody, anti-SSA/SSB, and autonomic ganglion acetylcholine receptor antibody tests are added. In addition, thyroid function tests, 24-hour urine sodium excretion, plasma volume measurement, quantitative sweat axon reflex test (QSART), and skin biopsy are performed, and it is essential to differentiate similar diseases such as pheochromocytoma, inappropriate sinus tachycardia, and hyperthyroidism. At the Osang Neurosurgery Autonomic Nerve Clinic, we identify the presence and subtype of POTS using a battery of precise autonomic nerve tests such as standing tilt, HRV, and qEEG. ### Standing incline table test (tilt test) ### Heart rate variability (HRV) analysis ### Blood catecholamine measurement and autoantibody test ## How do I treat and manage it? Non-drug treatments such as moisture and salt supplementation, compression clothing, and exercise rehabilitation are basic, and drug, immune, and neuromodulation treatments are combined depending on the subtype and symptoms. A combination of methods is most effective. ### Water and salt supplementation ### Compression clothing and posture management ### Exercise rehabilitation (Dallas protocol) ### medication ### Immune/neuromodulation treatment ### Neural Reset Protocol This is a treatment protocol aimed at stabilizing the overly elevated sympathetic nervous system and restoring the function of the parasympathetic nervous system (vagus nerve). ### NPT Program This is Osang Neurosurgery’s non-surgical physical therapy program that directly stimulates the autonomic and peripheral nerve pathways. FAQ ## Frequently Asked Questions We have summarized the most frequently asked questions from patients regarding orthostatic tachycardia syndrome. ### Q1What is postural orthostatic tachycardia syndrome (POTS)? It is an autonomic nervous system disease in which the heart rate increases abnormally when standing up, causing dizziness, palpitations, and fatigue. Blood pressure does not drop significantly, but the heart rate rises to more than 30 beats per minute. An accurate diagnosis is important because it is a dysregulation of the autonomic nervous system that is different from anemia or heart disease. ### Q2What causes POTS? There is more than one cause. There are neuropathic types in which lower extremity blood vessels contract poorly, hyperadrenergic types in which stress hormones are excessively secreted, and hypovolemic types in which blood volume in the body is insufficient. Cases that occur after viral infection or involve autoimmune mechanisms have also been reported. Since treatment varies depending on the cause, the subtype must be identified through detailed examination. ### Q3Why does it happen so often in young women? Approximately 80% of patients are women aged 15 to 50 years. This is believed to be because estrogen affects vascular tone and autonomic nervous responses. Women tend to have relatively weaker lower extremity muscle pumps and less blood volume in their bodies, which puts them at a disadvantage in blood flow distribution when standing. Symptoms fluctuate depending on the menstrual cycle, so periodic observation is helpful. ### Q4Can POTS occur after coronavirus infection? Yes, many cases of POTS occurring after COVID-19 infection have been reported worldwide. If severe fatigue, palpitations, and dizziness persist even after recovery, POTS may be suspected. It is presumed that the virus directly damages the autonomic nervous system or that the immune response affects the autonomic nervous system. If you are having a hard time with your daily life due to the aftereffects of the coronavirus, we recommend an autonomic nerve test. ### Q5What tests are used to diagnose POTS? Standing incline table examination (tilt test) is the standard diagnostic method. POTS is diagnosed if the heart rate rises more than 30 beats per minute within 10 minutes of lying down at an angle of 60 to 70 degrees and there is no orthostatic hypotension. Heart rate variability (HRV) analysis, blood catecholamine measurement, and autonomic function tests are added to differentiate subtypes. At Osang Neurosurgery, we perform these detailed tests together. ### Q6How is POTS treated? Non-drug treatments such as exercise rehabilitation, fluid and salt supplementation, and compression stockings are basic. There is a study that showed that if a progressive exercise program (Dallas protocol) was continued for more than 3 months, approximately 71% of patients improved below the diagnostic criteria. Medications such as low-dose beta blockers, midodrine, ivabradine, and fludrocortisone are prescribed depending on symptoms. Combining multiple methods is effective, so we recommend that you make a customized plan with a specialist. ## Postural Tachycardia Syndrome (POTS)Do you have any doubts? If you have recurring palpitations, dizziness, or brain fog when standing up, check with a detailed standing tilt and HRV test at the Gangnam Osang Neurosurgery Autonomic Nerve Clinic. ## Important notice This Markdown alternative helps search and AI tools understand the public page accurately. It provides general health information and does not replace an individual diagnosis or treatment.