Have you heard of postural orthostatic tachycardia syndrome, otherwise known as POTS?
A few years ago, a young patient of mine was diagnosed after months of suffering dreadful dizzy spells that left her unable to stand up. It came seemingly out of nowhere and meant she had to drop out of college.
Since then, I’ve become much more aware of POTS, and just how easily it can be missed.
Perhaps that shouldn’t be surprising. The condition is poorly understood, meaning many primary care doctors may not have encountered it during their training. Dizziness is one of those symptoms we see incredibly commonly, and working out what is causing it can be extraordinarily difficult.
There are dozens of possible explanations, from dehydration and low blood pressure to anemia, medication side effects and problems with the inner ear. Sometimes we struggle to find an obvious cause.
But POTS deserves to be on that list, particularly if the dizziness, racing heart or feeling of faintness comes on when you stand up and improves when you sit or lie down.
So if that sounds familiar, it is worth mentioning POTS to your doctor. And with increasing numbers of people – particularly women – now being diagnosed with it, it is a condition I think both doctors and patients need to be more aware of.
Dizziness is one of those symptoms of postural tachycardia syndrome, otherwise known as POTS
POTS is a problem with the autonomic nervous system – the part that controls functions we don’t consciously think about, such as sweating, digestion and changes in heart rate and blood pressure.
In people with POTS, the heart rate rises abnormally when they stand up. This can trigger dizziness, a pounding or racing heart, weakness and, in some cases, fainting.
Sufferers can also experience extreme fatigue, headaches, brain fog, digestive problems and changes in sweating.
There is a simple test that can help flag whether it might be the cause. Your heart rate and blood pressure can be measured while you are lying down and then repeatedly after you stand up. In adults with POTS, the heart rate typically rises by at least 30 beats per minute within ten minutes of standing, without the significant fall in blood pressure seen in some other conditions.
A smartwatch can provide useful clues, too. I’ve had patients show me readings demonstrating that their heart rate suddenly shoots up when they stand. Another clue can be unusually flexible joints.
If you are diagnosed, there are things you can do to make a real difference. One of the most important is surprisingly simple: fluids.
People with POTS are advised to drink about two to three liters a day, which helps maintain blood pressure. Increasing salt intake can also help, but that isn’t something anyone should do without medical advice.
Compression garments can help by reducing the amount of blood that pools in the lower body, which means the heart doesn’t have to work quite so hard to keep blood circulating.
There are medications that specialists can prescribe if these measures aren’t enough. There are currently no medications specifically approved by the FDA for POTS, so drugs are prescribed ‘off-label’ and treatment has to be tailored to the individual.
Some work by slowing the heart rate, while others help increase blood pressure or blood volume. Finding the right treatment can take time, and access to POTS specialists remains patchy.
The important thing is that persistent dizziness shouldn’t be something you live with. If there is a clear pattern to when it happens, tell your doctor.
The myth of blood thinners
I was saddened to see the inquest finding last week that the death of Richard Branson’s wife, Joan, could have been prevented if doctors had prescribed anti-clotting medication sooner.
Richard Branson with his late wife, Joan, 80, who died in hospital on November 2025
Called anticoagulants, or blood thinners, these drugs can be lifesaving for older adults, who are more prone to developing deadly blood clots and strokes than younger people.
Yet many doctors are still reluctant to prescribe them to older patients out of fear that their increased risk of falling could lead to potentially deadly brain bleeds.
Studies have shown, however, that this concern is largely misplaced – a patient would have to fall hundreds of times a year for the risk of bleeding to outweigh the protection against stroke.
I’d love to hear from readers about your experiences with blood thinners – both good and bad.
Please write in using the email address on the right and let me know.
Your questions answered
I’m 78 and constantly suffer from attacks of gout in my feet. My diet is healthy, so what should I do?
Dr Ellie replies: Gout is a type of arthritis caused by a buildup in the blood of a substance called urate, which can form tiny crystals in and around the joints.
It most commonly affects the big toe, causing sudden and often excruciating pain, heat, redness and swelling, but it can affect other joints.
If gout keeps coming back, there are two important possibilities to consider.
The first is that the urate level needs lowering. People who suffer frequent attacks are usually offered urate-lowering treatment, most commonly a daily drug called allopurinol.
Doctors use blood tests to monitor urate levels and gradually increase the dose until they reach a sufficiently low level to prevent crystals from forming and reduce the risk of further attacks. If you’re taking allopurinol but are still suffering from gout, ask your doctor whether your urate level is actually at the recommended target.
Losing excess weight and cutting down on alcohol can also help. Certain foods can contribute to high urate levels, but dietary changes alone are unlikely to be enough to control recurrent gout.
The other possibility is that it isn’t gout. It can sometimes be confused with other forms of arthritis.
If someone is suffering what they describe as almost constant gout despite treatment, I would want their doctor to reconsider whether the original diagnosis is correct.
One of the best ways to confirm gout is to take a small sample of fluid from a swollen joint using a needle – known as joint aspiration – and examine it for urate crystals. Ultrasound, X-rays and, in some circumstances, CT scans can also help doctors work out what type of arthritis is causing the problem.
So if gout attacks are continuing despite treatment, don’t simply assume that pain is inevitable.
Write to Dr Ellie: Do you have a question? Email DrEllie@mailonsunday.co.uk
