POTSOrthostatic Intolerance: Types and How POTS Fits In
Orthostatic intolerance explained in plain language: the umbrella term, its main types, and what each looks like on a stand test.
What orthostatic intolerance means
Orthostatic intolerance describes symptoms that appear when you stand or sit upright and ease when you lie down: lightheadedness, a pounding or racing heart, weakness, blurred vision and trouble thinking clearly. The term names a pattern of symptoms rather than a single disease (CCS 2020).
The main types, side by side
HEART RATE
SYSTOLIC PRESSURE
Heart rate rises at least 30 bpm within 10 minutes. Blood pressure holds.
- POTS. A sustained heart rate rise of at least 30 bpm within 10 minutes of standing in adults, without orthostatic hypotension (Freeman 2011).
- Orthostatic hypotension. A drop of at least 20 mmHg systolic or 10 mmHg diastolic within 3 minutes of standing (Freeman 2011).
- Vasovagal syncope. A faint, often with a trigger, from a sudden fall in heart rate and blood pressure (HRS 2015).
- Inappropriate sinus tachycardia. A fast resting heart rate that does not depend on posture (HRS 2015).
These overlap, and one person can show more than one. The dysautonomia overview covers the wider family. Measure blood pressure along with heart rate when you can, since it separates the types. See why blood pressure matters.
Other causes to rule out
CHECKED BEFORE A POTS LABEL
- Anemia
- Thyroid disease
- Dehydration
- Infection
- Pregnancy
- Some medicines
What to do next
If standing symptoms affect your week, book a visit and bring numbers. The home stand test guide explains how to collect them, and the visit checklist helps you organize them.
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
- Why Does My Heart Race When I Stand Up?
- POTS Heart Rate: How to Graph It with Apple Watch
- 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