Your heart races when you stand. Now what?

POTS (postural orthostatic tachycardia syndrome) is a form of dysautonomia. Your heart rate climbs sharply when you stand, and you feel symptoms such as dizziness, fatigue, palpitations or brain fog. Clinicians diagnose it from a measured heart rate rise plus symptoms, after they exclude other causes.

Published criteria describe a sustained rise of at least 30 beats per minute within 10 minutes of standing in adults, or at least 40 for ages 12 to 19, without a blood pressure drop that would indicate orthostatic hypotension. Symptoms must last at least 3 months (some criteria say 6), and a clinician must rule out other causes. Only a doctor can interpret your numbers.

Anxiety and POTS can look alike and can occur together. A measured heart rate on standing helps separate them better than a description of symptoms does, so ask your clinician to record lying and standing heart rate and blood pressure.

You can run a stand test at home: lie down and rest, then stand still for 10 minutes while you record heart rate and, if you can, blood pressure. A home test cannot diagnose POTS. It gives you and your doctor a measured record, which helps more than a description from memory.

Guidelines start with fluids, added salt when your doctor agrees, compression garments and graded exercise. Clinicians sometimes add medicines off label, and no drug has FDA approval for POTS. Treatment depends on your symptoms and your other conditions.

The free app guides a 20-minute stand test, graphs your heart rate and lets you mark symptoms. It records numbers and gives no diagnosis. A one-time $29 purchase unlocks PDF export, history beyond 30 days and insights. There is no subscription.