POTSWhy Does My Heart Race When I Stand Up?
Common reasons your heart rate jumps on standing, what a stand test measures, and when to see a doctor.
The short answer
Standing moves about half a liter of blood toward your legs. Your nervous system tightens blood vessels and raises your heart rate. Most people notice a small rise. A bigger or longer rise has several possible causes, and POTS is one of them (Freeman 2011).
Lying down
Blood spreads evenly. The heart rate settles.
Red shows blood. The gold heart beats at the example rate.
Common causes of a fast heart rate on standing
POTS
A sustained rise of at least 30 bpm within 10 minutes of standing in adults, without a large blood pressure drop.
Doctors check common, treatable causes such as anemia, thyroid disease and dehydration before considering POTS (HRS 2015). The POTS definition comes from CCS 2020.
What a stand test adds
A stand test records your resting heart rate, your heart rate at set minutes after standing, and blood pressure if you have a cuff. It separates a modest rise from a large sustained one and shows whether blood pressure dropped. See the home stand test guide.
HEART RATE (BPM) BY MINUTE AFTER STANDING
Systolic pressure holds steady after standing.
What to write down
- When it happens: on standing, after meals, in heat, in the shower, after exercise.
- How long it lasts and what else you feel: dizziness, vision dimming, chest tightness, shakiness, brain fog.
- Your resting heart rate on a calm morning.
- Medicines and caffeine that day.
When to get care right away
Call emergency services for chest pain, fainting with injury, severe shortness of breath, or a heart rate that stays very fast after you lie down. Book a visit soon if standing symptoms last for weeks or limit your day.
Tracking your readings
Repeated stand tests show a pattern that a single reading hides, and your doctor decides what the numbers mean. If you want a tool for it, see the POTS app.
This page informs and does not diagnose. Only a clinician who can examine you and see your whole history can interpret your numbers.
- Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Autonomic Neuroscience. 2011;161(1-2):46-48.
- 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;36(3):357-372.
- 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. 2015;12(6):e41-e63.
- What Is POTS? A Plain-Language Explanation
- How to Test for POTS at Home: The 10-Minute Stand Test
- POTS Symptoms: The Common Ones and What They Mean
- How POTS Is Diagnosed: Criteria, Stand Test and Tilt Table
- NASA Lean Test for POTS: How to Do It at Home
- Do I Have POTS? What to Check Before You See a Doctor
- Tests to Ask For When You Suspect POTS
- POTS Heart Rate: How to Graph It with Apple Watch
- Orthostatic Intolerance: Types and How POTS Fits In
- Why Blood Pressure Matters in a POTS Stand Test
- What Is Dysautonomia, and How Does It Relate to POTS?
- What Causes POTS? Subtypes, Triggers and What the Evidence Shows
- POTS and Long COVID: What the Research Shows
- POTS in Teens, Young Adults and During Pregnancy
- POTS Treatment Overview: What Guidelines Recommend First
- Fluids and Salt for POTS: What the Trials Show
- Compression and Exercise for POTS: Two First-Line Treatments
- POTS Medications: What Each One Does and What the Trials Show
- Living With POTS: Triggers, Pacing, Heat, Meals and Sleep
Want a record to bring to your visit? The POTS app guides the stand test at home and graphs your heart rate. See the app