PoTS: Postural Tachycardia Syndrome Guide for Care Staff

Postural tachycardia syndrome, usually called PoTS, is a condition in which the heart rate rises sharply when a person stands up. It can cause dizziness, palpitations and fainting, and it is frequently missed or put down to anxiety, dehydration or simple tiredness. This guide, based on NHS information reviewed in July 2026, explains what PoTS is, how it is diagnosed and managed, and what care and support staff can do to keep people safe. It is closely related to postural hypotension, which can look very similar and needs a different assessment.

What is PoTS?

The NHS describes PoTS as a condition where the heart rate increases abnormally after getting up from sitting or lying down, often causing dizziness or light-headedness. It is also written as POTS. The NHS states that there is no cure, but that it can be managed. The cause is unclear, and it can start suddenly or gradually.

Symptoms

On standing, the NHS says people may have dizziness, palpitations, chest pain, breathlessness, shaking, sweating, and fainting or near-fainting. Other symptoms can include stomach problems, headaches, vision changes, purple-looking hands or feet, tiredness, poor sleep and "brain fog". Symptoms are often worse in the morning and vary from day to day, and PoTS can resemble low blood pressure.

The NHS lists a range of triggers that can make symptoms worse, including heat, long periods of standing or sitting, meals high in carbohydrate, low fluid intake, alcohol, too much rest, exercise and periods. Recognising a person's own triggers is one of the most useful things staff can do.

Who is more likely to have PoTS?

The NHS notes that PoTS is more likely in people with long COVID, ME/CFS or joint hypermobility syndrome. If you support someone with these conditions and they report dizziness or a racing heart on standing, it is worth mentioning it to their GP. Our guides to long COVID and ME/CFS and NICE guideline NG206 explain these conditions in more detail.

How PoTS is diagnosed

According to the NHS, a GP will check blood pressure and heart rate before and after standing, which is known as an active stand test. Blood tests and an electrocardiogram (ECG) may be arranged to rule out other causes. The NHS says a specialist referral may be made if lifestyle changes do not help, if the person is very unwell or if the cause is unclear. Specialist tests can include urine tests, an echocardiogram, 24-hour heart monitoring and a tilt table test.

Treatment and self-help

The NHS advises that lifestyle changes come first:

• Drink more fluids. The NHS says to drink until urine is pale.
• Eat small meals with fewer carbohydrates.
• Wear compression tights or stockings if advised.
• Take gentle exercise, such as walking, pilates or swimming, and stop if symptoms occur.
• Raise the head of the bed, avoid standing for too long and get up slowly.
• Limit caffeine and alcohol.

If these measures do not help, medicines such as fludrocortisone or beta blockers may be tried, and the NHS notes that a person may need to try several. If someone feels faint, the NHS advises lying down and raising the legs, or crossing the legs, rocking on the toes or clenching muscles to help raise blood pressure.

Practical support for care staff

• Encourage slow position changes. Help people sit on the edge of the bed for a moment before standing.
• Plan the day around symptoms. Symptoms are often worse in the morning, so allow extra time for getting up and personal care.
• Offer drinks regularly. Make fluids easy to reach, and record intake where this is part of the care plan.
• Take care in hot environments. Hot baths, warm rooms and crowded places can trigger symptoms.
• Prevent falls. Fainting and near-fainting are a fall risk, so follow the person's falls plan and use any prescribed aids.
• Believe the person. Symptoms can be invisible and may vary each day, so avoid assuming someone is exaggerating.

When to get help

The NHS advises seeing a GP if you have PoTS symptoms, and this is a non-urgent step. Its page does not set out emergency advice, so staff should follow their organisation's procedures. If someone loses consciousness and does not recover quickly, has chest pain that does not settle, or is seriously unwell, call 999. For other concerns, NHS 111 can advise.

Frequently asked questions

Is PoTS the same as low blood pressure?

No. The NHS says it can resemble low blood pressure, but PoTS is about the heart rate rising when standing. A clinician will check both.

Can PoTS be cured?

The NHS says there is no cure, but symptoms can be managed with lifestyle measures and, if needed, medicines.

Can people with PoTS exercise?

Gentle exercise is suggested by the NHS, with a pause if symptoms occur. Plans should be agreed with a clinician.

Where can staff build their knowledge?

The health and social care learning available through Learnsignal CPD can help you keep your knowledge of long-term conditions up to date.

This article is general information for care staff, based on NHS information, and does not replace the advice of a person's own clinicians. If you are worried about someone's health right now, contact their GP, NHS 111 or, in an emergency, call 999.