Manage Postural Tachycardia Syndrome without medications via increased fluid intake (2–3 liters/day), higher salt consumption (3–5 grams/day with medical guidance), and compression stockings (20–30 mmHg). Gradual position changes and recumbent exercises, progressing to upright activities, improve symptoms and fitness. For severe cases, prescription options like fludrocortisone, low-dose beta-blockers, or midodrine may help, often requiring multidisciplinary care from cardiology, neurology, and physical therapy specialists.
January 14, 2025

POTS: Heart Rhythm Society Treatment Consensus

Evidence-Based Over-The-Counter Guide

William Shen

William Shen

Co-founder & CPO

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Postural Tachycardia Syndrome (POTS) is a condition characterized by an abnormal increase in heart rate upon standing, accompanied by symptoms like dizziness, fatigue, and palpitations. It presents with symptoms of orthostatic hypotension but without significant hypotension when standing. It is a type of dysautonomia, and treatment focuses on symptom management and improving quality of life.

First-line recommendations:

  • Fluid management: When you feel faint, drink water or an electrolyte-balance fluid like Gatorade. The peak effect occurs 30 minutes after ingestion of ≥240 mL and additional benefit seen with ≥480 mL. If you have no organ issues: Drink 2-3 liters of water daily and increase salt consumption 3-5 grams of salt (with medical guidance). 

  • Gradual position changes: Avoid sudden movements to reduce symptoms.

  • Compression stockings: 20-30 mmHg compressive pressure at least up to thighs to improve venous return. Should be worn long-term all day, every day. Elasticity is lost over time; use two pairs that should be alternated daily and replace after 6–9 months. Truform 20-30 Mmhg Compression Stockings.  

Exercise therapy:

  • Begin with recumbent exercises (e.g., swimming, recumbent cycling) and progress to upright exercises to improve cardiovascular fitness.

Prescription medications: 

  • Volume expansion: Fludrocortisone to promote fluid retention and increase blood volume.

  • Heart rate control: Beta-blockers (e.g., propranolol) at low doses to manage tachycardia.

  • Vasoconstriction: Midodrine to improve vascular tone for some refractory cases.

  • Multidisciplinary care: Collaboration with cardiology, neurology, and physical therapy teams for comprehensive management.


Citation

Sheldon RS, Grubb BP, Olshansky B, et al. 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope. Heart Rhythm. 2015; 12(6): p.e41-e63. doi: 10.1016/j.hrthm.2015.03.029

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