Watts Postural Orthostatic Tachycardia (POTS)?

POTS is a form of dysautonomia — a condition where the autonomic nervous system (ANS) doesn’t work properly. The ANS is like your body’s autopilot — it controls the things you don’t consciously think about, like heart rate, breathing, digestion, blood pressure, temperature, and sweating. When it’s dysregulated, things that should be automatic stop working efficiently. That’s where the chaos and pain begin.

In POTS, the most obvious problem is the sudden spike in heart rate when moving from sitting or lying to standing. For me, it means feeling dizzy, nauseous, shaky, or like I’m going to faint from doing absolutely nothing more dramatic than standing up — and sometimes even just sitting won’t get my heart rate to drop under 100bpm (current heart rate whilst sitting typing on a laptop is 109bpm — and no, I’m not stressed or anxious).

POTS is very frequently mistaken by others to be anxiety-related, or the result of being unfit, but it’s neither of these things. It’s the result of a system that’s supposed to just work, failing to self-regulate — often unpredictably.

🛠️ Watts the Treatment Strategy?

There’s no cure for POTS, but managing it means working with the nervous system as best you can. My current strategies include:

  • Salt and fluid loading (yes, I’ve basically turned into a human pretzel)
  • Compression garments to stop blood from pooling in my legs
  • Pacing and planning around symptoms — especially avoiding long periods of standing
  • Cooling aids like personal fans or ice packs for temperature control
  • Reclined or water-based movement including Pilates or hydrotherapy (on a good day)
  • Medications to help stabilise blood pressure and heart rate, noting that my other conditions prevent me using most recommended medications

One thing about POTS is it’s never consistent. I try to be well organised to help me stay upright more often than not. But POTS always fails to give advance notice of the severity or speed at which it will hit – and it does often leave me more shaken, sweaty and sleepy than sparkly, swearing or smiling. But so far, still surviving.

🩻 Watts the Diagnosis Process?

Diagnosis of POTS is typically based on heart rate changes during a tilt table test or active stand test. A heart rate increase of 30 beats per minute (or over 120bpm total) within 10 minutes of standing — without a significant drop in blood pressure — is considered diagnostic in adults. But like many conditions affecting the autonomic nervous system, it’s rarely that straightforward.

In my case, the process was long and invasive. I had a loop recorder implanted in my chest for three years to monitor my heart rhythm continuously. I also underwent multiple tilt table tests, stress tests, regular ECGs, 24-hour blood pressure monitoring, and eventually a cardiac ablation procedure.

Each of these helped rule out other cardiac causes — and slowly confirmed what had been clear from my symptoms for some time: my nervous system was failing to regulate my heart rate and blood flow properly. The diagnosis didn’t come quickly, and it didn’t come with a neat solution. But it gave a name to what was happening — and a direction for managing it.

🩺 Watts the Management Team?

POTS is another condition that doesn’t fall neatly under one medical specialty, and again, working with a multidisciplinary team of healthcare professionals who understand the condition really helps.

  • GP – for day-to-day care and referrals
  • Neurologist – for ongoing dysautonomia monitoring
  • Rheumatologist – for monitoring of immune and multi-systemic involvement
  • Cardiologist – for autonomic dysfunction
  • Pain Specialist – for oversight of some of the medication and interventions involved in POTS treatment
  • Physiotherapist and Exercise Physiologist – for strengthening and controlled exercise to maintain or improve orthostatic tolerance
  • Psychologist – for mental health support, CBT and coping strategies

Managing POTS can sometimes feel like navigating a minefield you never meant to step into — and having a supportive, knowledgeable treatment team can mean the difference between whether you spend your day sparkling… or swearing.

🧩 Related Conditions

For me, POTS overlaps with several other conditions that all seem to enjoy ganging up at the same time:

…You can check out my blog if you’re curious what it’s like living with a nervous system that behaves like a dodgy elevator: it either overshoots, undershoots, or skips floors entirely.

You can also visit the Helpful Links page for resources and organisations I’ve found useful along the way.

Disclaimer:
I’m not a doctor — just someone with a lot of medical letters on my file and a few too many hospital wristbands. Everything shared on this site comes from my personal experience living with complex chronic conditions. It’s not medical advice, and it shouldn’t replace professional guidance. Always speak to your healthcare team before making any treatment decisions (especially if it involves sparkles, spreadsheets, or ice cream therapy).

© WattsWithPain 2025