Have you heard of postural orthostatic tachycardia syndrome, better known as POTS?
A few years ago, one of my young patients was diagnosed with the condition after months of severe dizzy spells that made it impossible for her to stand. The symptoms appeared seemingly without warning and eventually forced her to leave college.
That experience made me far more alert to POTS — and to how easily the condition can go unrecognised.
Perhaps that is understandable. POTS remains poorly understood, so many primary care doctors may never have encountered it during their training. Dizziness is also an extremely common complaint, and identifying its underlying cause can be remarkably challenging.
The possible explanations are wide-ranging, including dehydration, low blood pressure, anemia, medication side effects and inner-ear disorders. In some cases, no obvious cause emerges.
POTS should nevertheless be considered, especially when dizziness, a racing heartbeat or a feeling of faintness develops after standing and eases when you sit or lie down.
If those symptoms sound familiar, consider asking your doctor about POTS. Diagnoses are increasing, particularly among women, making greater awareness of this condition important 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 regulates many involuntary functions, including sweating, digestion, heart rate and blood pressure.
For people with POTS, standing can cause the heart rate to rise abnormally. The resulting symptoms may include dizziness, a pounding or rapid heartbeat, weakness and, in some cases, fainting.
Other possible symptoms include profound fatigue, headaches, brain fog, digestive difficulties and changes in sweating.
A straightforward assessment can help indicate whether POTS may be involved. Heart rate and blood pressure are measured while a person is lying down, then checked repeatedly after they stand. In adults with POTS, the heart rate generally increases by at least 30 beats per minute within 10 minutes of standing, without the substantial drop in blood pressure associated with some other conditions.
A smartwatch may also offer useful clues. Some patients have shown me readings in which their heart rate rises sharply as soon as they stand. Unusually flexible joints can be another sign worth discussing with a doctor.
A diagnosis does not mean you are powerless to manage the symptoms. Several measures can help, beginning with one of the simplest: drinking enough fluids.
People with POTS are often advised to drink around two to three litres of fluid each day to help support blood pressure. Increasing salt intake may also be beneficial, but this should only be done after seeking 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. There are currently no medications specifically approved by the FDA for POTS, so drugs 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 drugs can be lifesaving for older adults, who are more prone to developing deadly blood clots and strokes than younger people.
Yet many doctors are still reluctant to prescribe them to older patients out of fear that their increased risk of falling could lead to potentially deadly brain bleeds.
Studies have shown, however, that this concern is largely misplaced – a patient would have to fall hundreds of times a year for the risk of bleeding to outweigh the protection against stroke.
I’d love to hear from readers about your experiences 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 buildup 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 from forming and reduce the risk of further attacks. If you’re taking allopurinol but are still suffering from gout, ask your doctor 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 doctor 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
