Post orthostatic tachycardia syndrome (POTS) is a disorder of the autonomic nervous system, the system that regulates involuntary processes in the body such as heart rate, blood pressure, sweating, and body temperature. A key sign of POTS is a marked increase in heart rate when standing.

Schedule an appointment with Saint Luke’s Cardiovascular Consultants by calling 816-931-1883.


POTS primarily affects women ages 15 to 50. While symptoms vary from person to person, them may include:

  • Severe and/or long-lasting fatigue
  • Lightheadedness with prolonged sitting or standing that can lead to fainting
  • Brain fog including trouble focusing, remembering, or paying attention
  • Forceful heartbeats or heart palpitations (a feeling of the heart pounding or skipping a beat)
  • Nausea and vomiting
  • Headaches
  • Excessive sweating
  • Shakiness
  • Intolerance of exercise or a prolonged worsening of general symptoms after increased activity
  • A pale face and purple discoloration of the hands and feet if the limbs are lower than the level of the heart

POTS symptoms typically get worse in a warm environment, during situations that involve a lot of standing, and if not enough fluids and salt have been consumed.


Because symptoms vary widely, treatment for POTS needs to be individualized to each patient. Treatment can be managed with lifestyle measures including increasing fluids and salt intake and using compression garments which can aid in the reduction of blood pooling and improve heart rate control. Improving sleep and exercising is also encouraged. Using cooling vests can also reduce the affects of heat. 

Medical therapy options for POTS include:

  • Beta blockers including propranolol to reduce heart rate 
  • Fludrocortisone which acts on the kidneys to conserve salt and thereby improve intervascular volume
  • Midodrine which is an alpha 1 agonist that causes vasoconstriction reducing venous pooling
  • Guanfacine is a central sympatholytics which reduces central sympathetic nervous system tone which is beneficial in patients with hyperadrenergic POTS
  • Pyridostigmine an acetylcholinesterase inhibitor which decreases the degradation in  acetyl choline therapy improving standing heart rates

Schedule an appointment with Saint Luke’s Cardiovascular Consultants by calling 816-931-1883.


John Kenneth Ngochua Lee, MD

Cardiology, Clinical Cardiac Electrophysiology