What are the symptoms of POTS and how do they affect daily life?
POTS combines difficulty tolerating an upright position with symptoms that can affect several body systems and limit daily activities.
- 8 sources
- 3 min read
- Clinical review
- Verified 8 November 2026
Key points
- POTS shows up mainly when standing: the heart speeds up sharply and symptoms appear, often easing when lying down. [1, 2]
- People with POTS also describe fatigue, trouble concentrating or digestive problems; none of these symptoms on its own is specific to POTS. [2, 3]
- POTS can limit daily activities, work, school and social life. [2, 4]
- How the rise in heart rate relates to how much someone is affected day to day is still poorly understood. [4]
- Having another condition at the same time (migraine, hypermobility, chronic fatigue syndrome) does not show that it causes POTS. [2, 4]
Definition
Symptoms linked to the heart and standing
Other reported symptoms
Conditions often seen alongside POTS
Mechanisms: leads, not a single explanation
What we still don’t know
References and level of evidence
- 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 12(6):e41-63 2015. DOI: 10.1016/j.hrthm.2015.03.029. PMID: 25980576.(guideline or consensus)Limitations: Expert consensus; several recommendations rest on a low level of evidence. Read: full text (HRS PDF).Declared conflicts of interest: Competing interests declared in the article's appendix.
- Vernino S, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1. Autonomic Neuroscience 235:102828 2021. DOI: 10.1016/j.autneu.2021.102828. PMID: 34144933.(guideline or consensus)Limitations: Summary of an expert meeting; according to the authors, figures on associated conditions come from small samples or uncontrolled surveys.Declared conflicts of interest: Competing interests declared individually in the article (consulting, grants, patents).
- Kulin D, Shah A, Fairlie T, et al. Gastrointestinal Symptoms and Systemic Comorbidities in Patients With POTS: A Systematic Review and Meta-Analysis. Neurogastroenterology & Motility 38(4):e70305 2026. DOI: 10.1111/nmo.70305. PMID: 41952073.(evidence synthesis)Limitations: 19 studies, 8,268 people; at least one digestive symptom in 57.9% of participants on average (95% CI 38.4–75.2); only one pediatric study; very high heterogeneity (I² = 99.3%); 11 of 19 studies from specialist centers; associated conditions often self-reported.Declared conflicts of interest: Several authors declare ties to the pharmaceutical industry (including G. Holtmann: Bayer, Glutagen, Australian Biotherapeutics).
- Raj SR, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): Priorities for POTS care and research from a 2019 National Institutes of Health Expert Consensus Meeting - Part 2. Autonomic Neuroscience 235:102836 2021. DOI: 10.1016/j.autneu.2021.102836. PMID: 34246578.(guideline or consensus)Limitations: Expert opinion on care and research priorities.Declared conflicts of interest: Declaration not consulted (full text not read as of 2026-11-08).
- Raj SR, Guzman JC, Harvey P, et al. Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance. Canadian Journal of Cardiology 36(3):357-372 2020. DOI: 10.1016/j.cjca.2019.12.024. PMID: 32145864.(guideline or consensus)Limitations: Professional society position statement; some recommendations rest on limited evidence.Declared conflicts of interest: Declaration not consulted (full text not read as of 2026-11-08).
- Raj SR, Fedorowski A, Sheldon RS. Diagnosis and management of postural orthostatic tachycardia syndrome. CMAJ 194(10):E378-E385 2022. DOI: 10.1503/cmaj.211373. PMID: 35288409.(evidence synthesis)Limitations: Narrative, non-systematic review. Read: full text (cmaj.ca).Declared conflicts of interest: All three authors declare research funding, fees or consulting activities; Raj and Sheldon also declare expert witness work or patents
- NHS. Postural tachycardia syndrome (PoTS). NHS website (page reviewed 2026-07-22) 2026.(expert opinion)Limitations: Public information page from a UK public body, not a clinical guideline.Declared conflicts of interest: Not applicable.
- Chung TH, Raj SR. Postural Orthostatic Tachycardia Syndrome (POTS): A Review. JAMA 336(13):1149-1164 2026. DOI: 10.1001/jama.2026.14809. PMID: 42635998.(evidence synthesis)Limitations: Narrative review; the authors state that the quality of evidence was not formally graded. Read: abstract + publisher excerpts; full text not checked.Declared conflicts of interest: Chung: personal fees from Argenx and Regeneron outside the submitted work; Raj: fees/consulting, advisory board and grants declared outside the submitted work