Standing up should not make your heart feel like it just ran across the parking lot.
But for people with POTS, also called Postural Orthostatic Tachycardia Syndrome, simple position changes can trigger a racing heart, dizziness, shakiness, fatigue, brain fog, chest discomfort, or feeling like you may faint. Some people notice symptoms when they stand in line. Others feel worse after a hot shower, a long day on their feet, a skipped meal, an illness, or exercise.
The frustrating part is that POTS can be hard to explain. You may look fine, but inside your body may feel unsteady, foggy, and exhausted. Many patients spend months or years being told their symptoms are stress, anxiety, dehydration, or “just being out of shape.”
POTS is real. It can affect daily life. And for many people, the right treatment plan can make symptoms more manageable.
At Prime Heart & Vascular, our cardiology team helps patients in Plano, Frisco, Allen, and the greater Dallas area understand symptoms like racing heart, dizziness, fainting, palpitations, and shortness of breath. If POTS may be part of the picture, the goal is to evaluate your symptoms carefully, rule out other heart related causes, and create a treatment plan that fits your body and your life.
What POTS Treatment Is Designed to Improve
POTS treatment is not about one magic pill or one simple fix. It is usually a combination plan designed to help your body tolerate standing more comfortably.
When you stand up, gravity naturally pulls blood toward your legs and lower body. In a healthy response, your nervous system, blood vessels, heart rate, and blood pressure work together to keep blood moving back to your heart and brain. In POTS, that response does not work as smoothly. Your heart rate may rise too much as your body tries to compensate.
Treatment is usually focused on improving blood volume, reducing blood pooling, calming the racing heart response, building better physical tolerance, and helping you avoid the triggers that make symptoms worse.
A good treatment plan should also answer an important question: Is this truly POTS, or could something else be causing similar symptoms?
That matters because dizziness, palpitations, fainting, chest discomfort, and shortness of breath can also be related to heart rhythm problems, anemia, thyroid issues, dehydration, medication side effects, blood pressure problems, pregnancy, infection, or other medical conditions.
How Cardiologists Confirm POTS Before Treatment Begins
Before treatment begins, your clinician needs to understand what happens to your heart rate and blood pressure when you change position.
POTS is commonly associated with a significant rise in heart rate after standing, without the kind of blood pressure drop seen in orthostatic hypotension. In adults, clinicians often look for a heart rate increase of at least 30 beats per minute within 10 minutes of standing. In adolescents, the heart rate change used for diagnosis is often higher.
But numbers alone are not the whole story. Symptoms matter. A careful evaluation may include a review of your medical history, fainting episodes, hydration habits, medications, recent illness, exercise tolerance, sleep, diet, and other symptoms.
Depending on your situation, testing may include:
- Heart rate and blood pressure checks while lying down, sitting, and standing
- Electrocardiogram
- Heart rhythm monitoring
- Echocardiogram
- Blood work to look for other possible causes
- Tilt table testing or autonomic testing when appropriate
The goal is not to label you quickly. The goal is to understand what your body is doing and why.
POTS Treatment Starts With Fluids, Salt, and Trigger Control
For many patients, the first part of POTS treatment involves improving circulating blood volume. This often means drinking more fluids and, when appropriate, increasing salt intake.
Salt helps the body hold on to fluid in the bloodstream. That can help more blood return to the heart and brain when you stand. This does not mean everyone should start eating large amounts of salt on their own. Salt and fluid recommendations should be individualized, especially for people with high blood pressure, kidney disease, heart disease, pregnancy, or other medical concerns.
Trigger control is also important. Many patients with POTS feel worse with heat, dehydration, alcohol, large heavy meals, long periods of standing, illness, poor sleep, and sudden increases in activity.
Helpful strategies may include:
- Drinking fluids steadily throughout the day
- Eating smaller meals if large meals make symptoms worse
- Avoiding long hot showers or hot tubs
- Planning breaks during long periods of standing
- Rising slowly from bed or from a chair
- Keeping a symptom log to identify patterns
Treating POTS often means learning your body’s warning signs before symptoms spiral.
Compression Garments Can Help Reduce Blood Pooling
Compression garments can help some people with POTS because they reduce blood pooling in the legs and lower body. When blood pools below the heart, less blood returns to the heart and brain. That can worsen lightheadedness, fatigue, palpitations, and weakness.
Many people think only of knee high compression socks, but some patients do better with compression that includes the abdomen and upper legs. That is because a large amount of blood can pool in the abdomen and pelvis, not just the calves.
Compression is not glamorous, but for the right patient, it can be useful. The key is choosing the right type, fit, and pressure level with guidance from your clinician.
A Gradual Exercise Plan Is a Core Part of POTS Treatment
Exercise can be one of the hardest parts of POTS treatment to talk about because many patients feel worse when they try to exercise.
That does not mean symptoms are imaginary. It means the plan needs to start at the right level.
For many people with POTS, upright exercise such as jogging, standing workouts, or intense cardio may be too much at first. A better starting point may include reclined or seated activity, such as a recumbent bike, rowing machine, swimming, gentle floor exercises, or physical therapy guided movement.
The idea is to start low and build slowly. Over time, a structured exercise plan may help improve conditioning, increase blood volume, and make standing easier to tolerate.
This part of treatment requires patience. Doing too much too quickly can cause setbacks. The goal is not to push through symptoms. The goal is to build capacity in a way your body can handle.
When Medication May Be Part of POTS Treatment
Medication may be considered when lifestyle changes, hydration, salt adjustment, compression, and exercise are not enough.
There is no single medication that works for every patient with POTS. Medications are chosen based on symptoms, blood pressure patterns, heart rate response, health history, and suspected POTS subtype.
Some medications may be used to help the body retain fluid. Others may help tighten blood vessels, reduce excessive heart rate, or improve nervous system signaling. Common medication categories used in POTS care may include beta blockers, medications that support blood vessel tightening, medications that help with sodium and fluid retention, and other options chosen for specific cases.
These medications require medical supervision. They can have side effects and may not be safe for everyone. A cardiologist can help determine whether medication is appropriate and how to monitor the response.
How POTS Treatment May Change Based on the Type of POTS
POTS does not look exactly the same in every patient. That is one reason treatment needs to be personalized.
Some people have low circulating blood volume. Some have more blood pooling due to blood vessel or nerve signaling issues. Some have a stronger adrenaline type response, with shakiness, pounding heartbeat, or higher blood pressure when standing. Some people have POTS along with other conditions, such as migraine, autoimmune disease, joint hypermobility, digestive issues, or chronic fatigue.
This is why a generic treatment list is not enough.
A helpful POTS treatment plan should answer questions like:
- Are symptoms mainly triggered by standing, heat, meals, dehydration, or exercise?
- Does blood pressure drop, stay steady, or rise?
- Is fainting part of the picture?
- Are palpitations due to sinus tachycardia or another rhythm issue?
- Are there medication side effects contributing to symptoms?
- Are there signs of anemia, thyroid disease, dehydration, or other medical problems?
- Do symptoms suggest another condition that should be evaluated?
The better the diagnosis, the more focused the treatment can be.
When to See a Cardiologist for POTS Symptoms
You should consider seeing a cardiologist if you frequently notice a racing heart, dizziness, fainting, or near fainting when you stand, shower, exercise, or spend time in heat.
It is especially important to get evaluated if symptoms are interfering with work, school, driving, exercise, or daily activities.
You should also seek care if you have chest discomfort, shortness of breath, unexplained fainting, worsening palpitations, or symptoms that feel new or severe.
POTS itself is usually not considered life threatening, but fainting can lead to injuries. Also, symptoms that seem like POTS can sometimes come from other heart or medical conditions that deserve attention.
POTS Treatment in Plano, Frisco, and Allen
Prime Heart & Vascular helps patients in Plano, Frisco, Allen, and the greater Dallas area evaluate symptoms that may be related to POTS or other cardiovascular concerns.
Our team takes time to listen, check the heart-related causes that may need attention, and help you understand the next step. For some patients, that may include lifestyle changes and monitoring. For others, it may include additional testing, medication, or coordination with other specialists.
If your heart races when you stand, you feel lightheaded often, or you have been told your symptoms are “just anxiety” but something still feels wrong, it is worth getting checked.
Learn more about POTS care at Prime Heart & Vascular by visiting our POTS Treatment page.
Schedule an appointment with Prime Heart and Vascular to talk with us about POTS.
Frequently asked questions about treating POTS
The first treatment for POTS often includes lifestyle changes such as increasing fluids, adjusting salt intake when appropriate, wearing compression garments, avoiding triggers, and starting a gradual exercise plan. The right starting point depends on your symptoms, blood pressure, heart rate response, and overall health.
Yes. A cardiologist can help evaluate symptoms such as racing heart, palpitations, dizziness, fainting, chest discomfort, and shortness of breath. A cardiologist can also help rule out rhythm problems or other heart conditions that may look similar to POTS.
There is no single cure that works for everyone, but many people improve with the right treatment plan. Symptoms may change over time, and some people have periods where they feel much better. Treatment is focused on improving daily function, reducing flare ups, and helping the body tolerate standing more comfortably.
For many people with POTS, drinking more fluids can help because it supports blood volume. However, fluid goals should be personalized. People with kidney disease, heart disease, high blood pressure, or other medical conditions should ask their clinician before making major changes.
Salt can help some people with POTS hold more fluid in the bloodstream, but it is not safe or appropriate for everyone. Talk with your clinician before significantly increasing salt, especially if you have high blood pressure, kidney problems, heart disease, or other medical concerns.
Common triggers include heat, dehydration, alcohol, standing for a long time, illness, poor sleep, skipped meals, large meals, and sudden increases in physical activity. Keeping a symptom log can help you and your clinician identify your personal triggers.
Exercise can help many people with POTS, but it needs to start slowly. Reclined or seated activity is often better tolerated at first than upright workouts. A structured plan may help improve conditioning and standing tolerance over time.
You should get checked if you regularly feel dizzy, faint, shaky, short of breath, or notice a racing heart after standing. You should also seek care if symptoms are affecting your daily life or if you have fainting, chest discomfort, or worsening palpitations.
