Chronic dizziness is a frustrating condition often dismissed as anxiety, dehydration, or simply stress. However, for many, the root cause may be something more specific: postural orthostatic tachycardia syndrome (POTS), a disorder of the autonomic nervous system that’s frequently overlooked by healthcare providers.
What is POTS?
POTS occurs when your body struggles to regulate heart rate and blood pressure upon standing. The autonomic nervous system, responsible for involuntary functions like digestion and heart rate, malfunctions. Specifically, POTS is diagnosed when heart rate increases by 30 beats per minute (or 40 for adolescents) within ten minutes of standing, without a corresponding drop in blood pressure.
Symptoms are wide-ranging, including:
- Orthostatic dizziness (dizziness when standing)
- Lightheadedness
- Fatigue
- Brain fog
- Heart palpitations
- Exercise intolerance
POTS disproportionately affects women – five times more often than men – and can emerge during puberty, after viral infections (like COVID-19), or hormonal shifts.
Why POTS Is Often Missed
The problem isn’t a lack of a diagnosis, but a lack of recognition. Neurologists typically focus on inner ear issues (vestibular migraines, persistent postural-perceptual dizziness) when dizziness is the primary complaint. POTS is often not included in standard medical training. This means it’s often “a missing piece in the puzzle.”
The overlap between POTS and anxiety further complicates matters. Both conditions share overlapping symptoms like racing heart, dizziness, and difficulty breathing, leading to misdiagnosis. Many patients are initially told their symptoms are psychological, delaying proper treatment by years.
How To Get Diagnosed
Diagnosing POTS is straightforward:
- 10-Minute Stand Test: A simple in-office assessment where heart rate and blood pressure are monitored after standing for ten minutes.
- Tilt Table Test: The gold standard, involving being strapped to a table that tilts to an upright position while monitoring vital signs.
If you suspect POTS, specifically request autonomic testing from your doctor. Not all providers are familiar with these tests, so consulting a cardiologist, neurologist, or autonomic specialist may be necessary.
Treatment & Advocacy
While there’s no cure, POTS symptoms can be managed with:
- Increased fluid and salt intake (under medical supervision).
- Compression garments.
- Gradual exercise programs.
- Stress management.
If chronic dizziness persists, advocate for yourself:
- Ask your doctor directly about POTS testing.
- Keep a detailed symptom diary.
- Seek a second opinion if dismissed.
Chronic dizziness isn’t always “just stress.” POTS is a real, diagnosable condition that deserves consideration, especially when other explanations fall short.
Ignoring the possibility of POTS means overlooking a significant cause of chronic dizziness. Proper evaluation is essential for those whose symptoms remain unexplained.
