Health Mechanisms

Topics / POTS

What is POTS?

What POTS is, what the published criteria say, who it affects and what is still debated, with the level of evidence behind each statement.

  • 16 sources
  • 7 min read
  • Clinical review
  • Verified 8 November 2026

Key points

  • POTS (postural orthostatic tachycardia syndrome) is a syndrome: a pattern of symptoms and measurements, not a single disease with one cause. [5]
  • It combines symptoms that come on when upright and ease when lying down with a marked rise in heart rate on standing, without a significant fall in blood pressure. [1, 2]
  • How common it is has not been properly studied. Current estimates rest mostly on clinical experience. [2]
  • Links with hypermobility and long COVID are being researched, but how strong they are remains uncertain; for MCAS, the link itself is not confirmed by a recent systematic review. [2, 12, 13, 14]

Definition

POTS belongs to the orthostatic intolerance disorders: difficulty staying upright because the body does not adjust well to standing. Professional societies and expert groups describe it as a clinical syndrome rather than a specific disease, probably driven by different mechanisms in different people. [5, 2]

You may also see it written as “postural tachycardia syndrome” or “PoTS”.

What the published criteria say

The criteria below summarize what professional societies have written. They are not a self-test: only a clinical assessment can apply them, after looking for other explanations first.

Reported symptoms

The most commonly reported symptoms start or worsen when upright: lightheadedness or feeling about to faint, palpitations, tremor, weakness, blurred vision, fatigue and poor exercise tolerance. [1]

In a large online survey of people reporting this diagnosis, nearly all reported lightheadedness and a racing heart; headaches and difficulty concentrating were also very common. [9] (observational study) Participants volunteered through an advocacy group, so their answers describe lived experience but cannot tell us how common each symptom is across everyone with POTS.

Who is affected

Reference statements describe mostly women and young people: more than three in four patients are female, and most first present between about 15 and 25. [1] The NIH consensus describes the typical patient as a woman aged 12 to 50. [2]

In the same online survey, the median time from first seeing a doctor for these symptoms to diagnosis was two years. [9]

The NIH consensus lists triggers people report before symptoms began (viral illness, concussion, first periods, pregnancy, surgery) and notes that what is known about the long-term course rests on incomplete data. [2]

Mechanisms: what is known and what is hypothesized

Conditions often seen alongside POTS

Occurring together is not the same as one causing the other. The figures below come mostly from small samples, specialist centers or self-reported surveys [2, 4]: they do not describe everyone with POTS.

  • Hypermobility and hypermobile EDS (hEDS). In a study of 91 people with POTS, 31% met the 2017 hEDS criteria, and a further 24% had generalized joint hypermobility without meeting them. [10] (observational study) A 2026 systematic review, read from its abstract and covering EDS in general (types and criteria varied between studies), reports EDS in 17.9% to 50% of POTS patients depending on the populations studied; these are not general-population prevalence figures. [16] A review of ten studies found orthostatic intolerance symptoms more often in people with joint hypermobility or EDS than in healthy people; study methods varied. [11] See Hypermobility and POTS.
  • MCAS. A 2025 systematic review found no study in which a mast cell disorder or hereditary alpha-tryptasemia, diagnosed by strict criteria, was found in people with POTS or EDS; one came close to the full criteria for mast cell activation syndrome. It therefore cannot confirm the POTS–EDS–MCAS “triad” often described online. [12] (evidence synthesis)
  • Long COVID. A professional society has reported, based on case reports, POTS developing in some people after COVID-19. [13] Among people already symptomatic after COVID-19, a meta-analysis published in late 2025 (January 2026 issue) found POTS in 36% on average, with results varying widely between studies; after correcting for publication bias, the estimate falls to 8.7%, with wide uncertainty. [14] These figures do not apply to everyone who has had COVID-19. In a database of adult health records (64 healthcare organizations), new recorded diagnoses rose sharply after March 2020; the authors see a possible link with post-viral POTS. [15] Better recognition of the diagnosis may also play a part (our reading, not demonstrated).
  • Other associations described, with evidence the authors themselves rate as weak: migraine, ME/CFS, fibromyalgia and autoimmune conditions. [4, 2]

Differences between countries and age groups

The main reference statements are American, Canadian and European, and they do not agree on every detail (see above). No guidance from NICE (the UK’s National Institute for Health and Care Excellence) or HAS (France) dedicated to POTS was identified: HAS covers it in its post-COVID care guide (see POTS and long COVID), and NICE mentions it in its ME/CFS guideline (see POTS management).

For ages 12 to 19, the consensus statements use a threshold of 40 beats per minute [1, 2]; whether it fits young people is debated, notably because healthy children and adolescents often reach large rises on tilt testing [7], and criteria remain poorly defined before age 12. See POTS in adolescents.

What we still don’t know

When to talk to a doctor

If symptoms keep coming back when you are upright and get in the way of daily life, it is worth raising them with your doctor. Assessment, carried out by a health professional, usually involves measuring heart rate and blood pressure lying down and then standing, and looking for other causes. [4] This page cannot tell you whether you have POTS.

References and level of evidence

  1. Sheldon RS, Grubb BP 2nd, 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. DOI: 10.1016/j.hrthm.2015.03.029. PMID: 25980576.(guideline or consensus)
    Limitations: Expert consensus; epidemiology based on four older reports. Read: full text (HRS PDF).
    Declared conflicts of interest: Industry relationships disclosed in appendices.
  2. 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 2021. DOI: 10.1016/j.autneu.2021.102828. PMID: 34144933.(guideline or consensus)
    Limitations: Summary of an expert meeting; comorbidity figures come, as the authors state, from small samples or uncontrolled surveys. Full text read.
    Declared conflicts of interest: Declared individually, including ties to Dysautonomia International.
  3. 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 2021. DOI: 10.1016/j.autneu.2021.102836. PMID: 34246578.(guideline or consensus)
    Limitations: Expert view on priorities. Abstract read.
  4. Raj SR, Fedorowski A, Sheldon RS. Diagnosis and management of postural orthostatic tachycardia syndrome. CMAJ 2022. DOI: 10.1503/cmaj.211373. PMID: 35288409.(evidence synthesis)
    Limitations: Narrative (non-systematic) review; the authors rate the evidence on comorbidities as weak. Read: full text (cmaj.ca).
    Declared conflicts of interest: Research support and consultancies declared.
  5. 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 2020. DOI: 10.1016/j.cjca.2019.12.024. PMID: 32145864.(guideline or consensus)
    Limitations: Position statement based on a systematic review (GRADE method). Abstract only read: cited here only for what it states.
  6. Brignole M, Moya A, de Lange FJ, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. European Heart Journal 2018. DOI: 10.1093/eurheartj/ehy037. PMID: 29562304.(guideline or consensus)
    Limitations: Syncope guideline; POTS is covered secondarily (class IIa, level C). Full text read.
  7. Singer W, Sletten DM, Opfer-Gehrking TL, et al. Postural tachycardia in children and adolescents: what is abnormal?. The Journal of Pediatrics 2012. DOI: 10.1016/j.jpeds.2011.08.054. PMID: 21996154.(observational study)
    Limitations: Single center, 5-minute tilt; proposed criteria not validated.
  8. Sivakoti K, Cortez MM, Fedorowski A, et al. Postural orthostatic tachycardia syndrome (POTS) and dysautonomia: International multidisciplinary expert consensus. The American Journal of Medicine 2026. DOI: 10.1016/j.amjmed.2026.08.012. PMID: 42665152.(guideline or consensus)
    Limitations: Delphi consensus published online ahead of print (August 2026). Abstract only read.
    Declared conflicts of interest: Not verified (full text not read).
  9. Shaw BH, Stiles LE, Bourne K, et al. The face of postural tachycardia syndrome - insights from a large cross-sectional online community-based survey. Journal of Internal Medicine 2019. DOI: 10.1111/joim.12895. PMID: 30861229.(observational study)
    Limitations: Online survey of volunteers recruited through an advocacy group; diagnoses and comorbidities self-reported, not confirmed; not representative.
  10. Miller AJ, Stiles LE, Sheehan T, et al. Prevalence of hypermobile Ehlers-Danlos syndrome in postural orthostatic tachycardia syndrome. Autonomic Neuroscience 2020. DOI: 10.1016/j.autneu.2020.102637. PMID: 31954224.(observational study)
    Limitations: 91 participants recruited in a specialist setting, no control group.
  11. Roma M, Marden CL, De Wandele I, et al. Postural tachycardia syndrome and other forms of orthostatic intolerance in Ehlers-Danlos syndrome. Autonomic Neuroscience 2018. DOI: 10.1016/j.autneu.2018.02.006. PMID: 29519641.(evidence synthesis)
    Limitations: Review of 10 studies with heterogeneous methods, without a formal systematic protocol.
  12. Farley M, Estrada-Mendizabal RJ, Gansert EA, et al. Prevalence of mast cell activation disorders and hereditary alpha tryptasemia among patients with postural orthostatic tachycardia syndrome and Ehlers-Danlos syndrome: A systematic review. Annals of Allergy, Asthma & Immunology 2025. DOI: 10.1016/j.anai.2025.03.022. PMID: 40185471.(evidence synthesis)
    Limitations: Systematic review; conclusion limited by the lack of studies using strict diagnostic criteria.
  13. Raj SR, Arnold AC, Barboi A, et al. Long-COVID postural tachycardia syndrome: an American Autonomic Society statement. Clinical Autonomic Research 2021. DOI: 10.1007/s10286-021-00798-2. PMID: 33740207.(expert opinion)
    Limitations: Professional society statement.
    Declared conflicts of interest: Industry and advocacy ties declared.
  14. Wang C, Fan Y, Li C, et al. The prevalence of orthostatic intolerance, postural orthostatic tachycardia syndrome and orthostatic hypotension in post-acute sequelae of COVID-19. Frontiers in Cardiovascular Medicine 2025. DOI: 10.3389/fcvm.2025.1679252. PMID: 41584279.(evidence synthesis)
    Limitations: Meta-analysis (21 studies, 15 for POTS); very high heterogeneity and publication bias: bias-adjusted estimate 8.7% (95% CI 0-30.8). Covers people already symptomatic after COVID-19. eCollection 2025 (issue dated January 2026).
  15. Dulal D, Maraey A, Elsharnoby H, et al. Impact of COVID-19 pandemic on the incidence and prevalence of postural orthostatic tachycardia syndrome. European Heart Journal - Quality of Care and Clinical Outcomes 2025. DOI: 10.1093/ehjqcco/qcae111. PMID: 39775762.(observational study)
    Limitations: Coded health records of US adults (TriNetX); full text not read.
  16. Kwok CS, Hagger G, Gillespie D, Hall M, Nazari B, Chong D, Hinton J, Qureshi AI, Raj SR. The co-existence of Ehlers-Danlos syndrome and postural orthostatic tachycardia syndrome: A systematic review of the literature. Autonomic Neuroscience, 267:103453 2026. DOI: 10.1016/j.autneu.2026.103453. PMID: 42398445.(evidence synthesis)
    Limitations: 30 studies (8,421 EDS patients, 12,983 POTS patients) with very different populations and definitions; proportions presented as ranges. Read: abstract.
    Declared conflicts of interest: Not reviewed in the part of the source that was read
Written by
Claude (AI-assisted drafting)
Editor
Jean Viry-Babel
Review status
Clinical review: Dr Françoise Charmoillaux (anesthesiologist)
Approved on
8 November 2026
Literature search
31 October 2026
Last verified
8 November 2026
Geographic scope
international, United States, France
Audience
adults
Conflicts of interest
No known financial ties. Separately, the publisher is developing a personal approach to these conditions under the name Connected Conditions, which is not cited here (see the legal notice).
Limitations of this page
Definition page: does not cover treatment or what to do. No UK (NICE) or French (HAS) guidance dedicated to POTS was identified; HAS covers it in its post-COVID guide and NICE in its ME/CFS guideline. Several sources were verified from their abstract or record only (noted for each reference).