Have you come across postural tachycardia syndrome, better known as PoTS?
Several years ago, one of my young patients was diagnosed after months of debilitating dizzy spells that made it almost impossible for her to remain standing. The symptoms appeared unexpectedly and became so disruptive that she was forced to leave college.
That experience made me far more alert to PoTS — and to how easily this condition can go unrecognised.
Part of the problem is that PoTS remains poorly understood, so many GPs may never have encountered it during their medical training. Dizziness is also an extremely common complaint, and identifying its precise cause is not always straightforward.
Possible explanations range from dehydration and low blood pressure to anaemia, side effects from medicines and disorders affecting the inner ear. In some cases, no clear cause is found at first.
PoTS should nevertheless be considered, especially when dizziness, a rapid heartbeat or near-fainting begins after standing and eases when a person sits or lies down.
If those symptoms sound familiar, raising the possibility of PoTS with your GP may be worthwhile. Diagnosis rates are increasing, particularly among women, making greater awareness essential for both patients and healthcare professionals.
Dizziness is a common symptom of postural tachycardia syndrome, also known as PoTS
PoTS affects the autonomic nervous system, which manages many automatic processes in the body, including sweating, digestion, blood pressure and changes in heart rate.
For people with PoTS, standing can cause the heart rate to increase unusually sharply. This may lead to dizziness, a pounding or racing heartbeat, weakness and, in some cases, loss of consciousness.
Other possible symptoms include profound tiredness, headaches, difficulty concentrating or “brain fog”, digestive disturbances and altered sweating.
A straightforward assessment can help indicate whether PoTS may be involved. Heart rate and blood pressure are recorded while a person is lying down, then checked at intervals after they stand. In adults with PoTS, the heart rate generally rises by at least 30 beats per minute within 10 minutes of standing, without the marked drop in blood pressure associated with some other conditions.
A smartwatch can provide useful clues, too. I’ve had patients show me readings demonstrating that their heart rate suddenly shoots up when they stand. Another clue can be unusually flexible joints.
If you are diagnosed, there are things you can do to make a real difference. One of the most important is surprisingly simple: fluids.
People with PoTS are advised to drink about two to three litres a day, which helps to maintain blood pressure. Increasing salt intake can also do this, but that isn’t something anyone should do without medical advice.
Compression garments can help by reducing the amount of blood that pools in the lower body, which means the heart doesn’t have to work quite so hard to keep blood circulating.
There are medications that specialists can prescribe, if these measures aren’t enough. None is currently specifically licensed in the UK for treating PoTS, so they are prescribed ‘off-label’ and treatment has to be tailored to the individual.
Some work by slowing the heart rate, while others help increase blood pressure or blood volume. Finding the right treatment can take time, and access to PoTS specialists remains patchy.
The important thing is that persistent dizziness shouldn’t be something you live with. If there is a clear pattern to when it happens, tell your doctor.
The myth of blood thinners
I was saddened to see the inquest finding last week that the death of Richard Branson’s wife, Joan, could have been prevented if doctors had prescribed anti-clotting medication sooner.
Richard Branson with his late wife, Joan, 80, who died in hospital on November 2025
Called anticoagulants, or blood thinners, these can be lifesaving for older adults who are more prone to developing deadly blood clots and strokes than young people.
But many doctors are still reluctant to prescribe them to older patients out of fear that their increased risk of falling will lead to more brain bleeds.
But studies have shown this worry is based on myth – a patient would have to fall hundreds of times a year for the risk of bleeding to outweigh that of stroke.
I’d love to hear from readers about your experience with blood thinners – both good and bad.
Please write in using the email address on the right and let me know.
Your questions answered
I’m 78 and constantly suffer from attacks of gout in my feet. My diet is healthy, so what should I do?
Dr Ellie replies: Gout is a type of arthritis caused by a build-up in the blood of a substance called urate, which can form tiny crystals in and around the joints.
It most commonly affects the big toe, causing sudden and often excruciating pain, heat, redness and swelling, but it can affect other joints.
If gout keeps coming back, there are two important possibilities to consider.
The first is that the urate level needs lowering. People who suffer frequent attacks are usually offered urate-lowering treatment, most commonly a daily drug called allopurinol.
Doctors use blood tests to monitor urate levels and gradually increase the dose until they reach a sufficiently low level to prevent crystals forming and reduce the risk of further attacks. If you’re taking allopurinol but are still suffering gout, ask your GP whether your urate level is actually at the recommended target.
Losing excess weight and cutting down on alcohol can also help. Certain foods can contribute to high urate levels, but dietary changes alone are unlikely to be enough to control recurrent gout.
The other possibility is that it isn’t gout. It can sometimes be confused with other forms of arthritis.
If someone is suffering what they describe as almost constant gout despite treatment, I would want their GP to reconsider whether the original diagnosis is correct.
One of the best ways to confirm gout is to take a small sample of fluid from a swollen joint using a needle – known as joint aspiration – and examine it for urate crystals. Ultrasound, X-rays and, in some circumstances, CT scans can also help doctors work out what type of arthritis is causing the problem.
So if gout attacks are continuing despite treatment, don’t simply assume that pain is inevitable.
Write to Dr Ellie: Do you have a question? Email DrEllie@mailonsunday.co.uk
