Postural orthostatic tachycardia syndrome
POTS (Postural Orthostatic Tachycardia Syndrome): Symptoms & Support
POTS can make ordinary upright activities — standing in the kitchen, showering, walking through a store, simply getting ready for the day — feel unexpectedly difficult.
Dizziness, a racing heart, fatigue, brain fog and the uncertainty of not knowing how your body will respond can start to shape far more than the physical symptoms themselves.
re-origin combines neuroplasticity education, brain-body practices, nervous-system regulation tools, coaching and community to help members work with the stress, vigilance, symptom monitoring and loss of confidence that can develop around persistent symptoms. It does not diagnose or treat POTS and does not replace medical care.
At a glance
POTS at a glance
- What it is
- A form of orthostatic intolerance in which being upright is associated with an excessive increase in heart rate and symptoms such as lightheadedness, palpitations, fatigue and cognitive difficulty.1
- One characteristic diagnostic finding
- A sustained heart-rate rise of ≥30 bpm in adults or ≥40 bpm in adolescents within 10 minutes upright, without significant orthostatic hypotension. Diagnosis also considers persistent upright symptoms and other possible causes.47
- Not one mechanism
- POTS is heterogeneous and multifactorial. Research describes several contributing mechanisms, and they remain incompletely understood.15
- More than the heart rate
- Fatigue, brain fog, exercise intolerance and unpredictability often affect daily life as much as the cardiovascular symptoms.2
- Not anxiety
- Some symptoms overlap, and unpredictable symptoms are genuinely distressing — but POTS is a recognised physiological syndrome and should not be dismissed as anxiety.
- Where re-origin fits
- Support for the vigilance, anticipation, attention, confidence and routines that can build around persistent symptoms. Not a treatment for POTS.
Self-assessment
Wondering whether your symptoms resemble POTS?
Explore the POTS self-assessment to reflect on common patterns and decide whether further professional assessment may be useful.
This self-assessment may help you organise and reflect on symptoms. It cannot diagnose a condition, determine the cause of symptoms or replace assessment by a qualified healthcare professional.
Lived experience
When standing becomes something you have to think about
Queues. Showers. Cooking a meal. Getting dressed. Walking the length of a store. Waiting rooms. A warm day. Any stretch of time spent upright. For many people with POTS, these are the moments that need planning rather than the ones that happen without thought.
Sometimes it means sitting down on the floor unexpectedly, or leaving a shop early, or judging every plan by whether there will be somewhere to sit. Not everyone experiences all of this, and the same activity may be fine one day and not the next — which is often the hardest part to explain to other people.
Lying or sitting
Symptoms are often quieter. This is the position many people return to.
Standing up
Getting up, or staying up — in a queue, a shower, a kitchen.
Heart rate and symptoms build
Racing heart, lightheadedness, shakiness, fog, sometimes nausea.
Needing to sit or lie down
Often followed by fatigue, and by wondering what the next attempt will bring.
An illustration of a commonly described daily pattern — not a biological mechanism, and not everyone’s experience.
The re-origin approach
When your nervous system starts anticipating what happens next
Repeated unpredictable symptoms affect more than the original physical condition. People begin watching heart rate, dizziness, sensations and energy very closely. Plans get organised around avoiding another difficult episode. A frightening experience last month shapes what this afternoon feels like.
These responses are understandable. They are also areas where neuroplasticity and nervous-system regulation can become relevant, because attention, anticipation, stress responses and confidence are shaped by experience and can change over time.
Working with these patterns does not mean they caused POTS, and it never means pushing past your current capacity.
What members work on here
- Hypervigilance and constant symptom monitoring
- Anticipatory stress around standing or activity
- Fear following a previous episode
- Reduced confidence, and emotional activation around physical sensations
- Rigid protective routines that build up over time
- Attention repeatedly pulled towards symptoms
- Rebuilding confidence in everyday activities within current capacity.
What is included
What members receive
Science-informed neuroplasticity programs, practices, coaching, and community for nervous system regulation. Built by people who've lived it. Designed to meet you where you are. Carried by community.
Brain retraining
Structured practices that give members opportunities to respond differently to familiar stress, attention and behavioural patterns.
Nervous-system regulation
Develop a wider repertoire of responses for moments when stress, uncertainty or activation feels intense.
Somatic practices
Work with physical activation and body-based responses through gentle practices that can be adapted to the individual.
Neuroplasticity education
Understand how experience, attention, repetition and learning can shape nervous-system responses over time.
Coaching
Get help applying the Program to real-life situations, setbacks and difficult grey areas. Coaching, not psychotherapy.
Community
Connect with people who understand persistent symptoms, nervous-system sensitivity and the effect they can have on everyday life.
One member's experience
Autumn's experience with POTS
Autumn experienced POTS alongside Lyme disease and autoimmune health challenges. In her story she talks about fainting, fatigue, dizziness and the impact persistent symptoms had on her independence — and how re-origin became part of her own recovery journey.
Autumn’s story reflects her individual experience. Results vary, and personal testimonials do not establish that re-origin treats or cures POTS.
The basics
What POTS is
POTS is a form of orthostatic intolerance in which being upright is associated with an excessive increase in heart rate and symptoms such as lightheadedness, palpitations, fatigue and cognitive difficulty.18
Where diagnostic criteria are used, the characteristic finding is a sustained heart-rate rise within 10 minutes of becoming upright — at least 30 bpm in adults and at least 40 bpm in adolescents — in the absence of orthostatic hypotension.47 A drop in blood pressure on standing is a different finding and is not part of the POTS pattern.
POTS is heterogeneous and multifactorial. Several contributing mechanisms are described in the research literature, they may differ between individuals, and they are still incompletely understood.156 No single explanation — physiological or psychological — accounts for every case.
Why upright posture matters
Why standing can trigger symptoms
Standing up moves a volume of blood towards the lower body. The circulatory and autonomic systems normally compensate within seconds, so that blood flow to the brain is maintained and you notice nothing at all.6
In POTS that adjustment involves a much larger and more sustained rise in heart rate, accompanied by symptoms.1 Why differs between people: reduced blood volume, changes in blood-vessel constriction, and altered autonomic signalling have all been described, and more than one may apply to the same person.56
This is why the everyday pattern is so recognisable — the trigger is a posture, not an activity. It is also why symptoms can appear during something as undemanding as standing still.
Everyday life
Common symptoms and triggers in everyday life
Symptoms and triggers differ between people and may change over time. Other physical or mental-health conditions can coexist and may require separate assessment and support.
Commonly reported symptoms
Commonly reported triggers
- Prolonged standing — queues, waiting rooms, cooking
- Heat, hot showers or baths
- Getting up quickly, or after a long period lying down
- Large meals, dehydration or illness
- Physical exertion, depending on the person.
New, severe, worsening or unexplained symptoms deserve appropriate medical assessment, particularly where the cause of dizziness, fainting, heart-rate changes or other symptoms is uncertain. re-origin does not replace medical diagnosis or care.
Neuroplasticity
Why neuroplasticity matters when symptoms have changed the way you live
Neuroplasticity is the nervous system’s capacity to change through experience and learning. Repeated episodes of dizziness, racing heart, fatigue, fainting or uncertainty can influence attention, expectation, stress responses, habits and confidence. Brain retraining gives members structured opportunities to practise different responses around those secondary patterns.
POTS is a real physiological syndrome. Neuroplasticity provides a way to work with the nervous-system and behavioural patterns that may develop around the experience of persistent symptoms.
What this can apply to
- Anticipating symptoms before standing or going out
- Checking and monitoring the body constantly
- Settling after a frightening episode
- Confidence and participation within current capacity
What members practise
Less automatic symptom monitoring
Practise shifting attention when constant checking is adding additional stress.
More flexible responses to uncertainty
Build more choice in how you respond when symptoms or unpredictability activate a stress response.
Greater confidence within current capacity
Support participation and decision-making without asking members to ignore symptoms or exceed current limits.
Neuroplasticity work does not mean POTS is imagined, learned or caused by stress, and it does not replace appropriate medical care.
Related resources
Where to go next
POTS self-assessment
Reflect on common patterns and whether professional assessment may help.
Racing heart & tachycardia
The symptom on its own, and what else can contribute to it.
Dizziness & lightheadedness
When it happens, what it can mean, and when to seek assessment.
What is neuroplasticity?
How the nervous system changes through learning — and its limits.
Science & Results
The research re-origin draws on.
The re-origin Program
Education, practices, somatic tools, coaching and community.
Questions
Frequently asked questions
What does POTS feel like?
Many people describe lightheadedness, a pounding or racing heart, shakiness, fatigue, difficulty thinking clearly, and sometimes nausea, headache or a need to sit or lie down. Symptoms are usually worse when upright and often ease on lying down, though experiences differ.
Why do POTS symptoms get worse when standing?
Standing shifts blood towards the lower body, and the cardiovascular and autonomic systems adjust to maintain circulation to the brain. In POTS that adjustment involves a larger, sustained rise in heart rate along with symptoms. The mechanisms behind it differ between people and are still incompletely understood.
Can POTS cause fatigue and brain fog?
Fatigue and cognitive difficulty are among the most commonly reported symptoms alongside the heart-rate response, and for many people they affect daily life as much as the more obvious cardiovascular symptoms.
Can heat or showering make POTS symptoms worse?
Many people find heat, hot showers, standing for a long time, large meals, illness or dehydration make symptoms more noticeable. Triggers vary, and what affects one person may not affect another.
Is POTS the same as anxiety?
No. POTS is a recognised form of orthostatic intolerance with a measurable heart-rate response to being upright. Some symptoms overlap with anxiety, and living with unpredictable symptoms can be genuinely distressing, but POTS is not anxiety and should not be dismissed as it.
What is the relationship between POTS and the autonomic nervous system?
POTS is classed among the disorders of orthostatic intolerance involving autonomic cardiovascular control. It is heterogeneous: research describes several contributing mechanisms rather than one, and no single explanation accounts for every case.
Can neuroplasticity or brain retraining help someone living with POTS?
Neuroplasticity is the nervous system’s capacity to change through experience and learning. It offers a way to work with the secondary patterns that can build around persistent symptoms — vigilance, anticipation, attention, confidence and habits. It is not a treatment for POTS and does not change the underlying physiology.
How does re-origin support people with persistent POTS symptoms?
re-origin gives members neuroplasticity education, structured brain-body practices, nervous-system regulation and somatic tools, coaching and community, to work with stress responses, symptom monitoring, anticipatory fear, confidence and everyday participation within current capacity. It does not diagnose or treat POTS and does not replace medical care.
You know what your body does when you stand. You can also work with what builds around it.
POTS can affect far more than heart rate. Vigilance, anticipation, reduced confidence and increasingly restricted routines can become part of everyday life too — and those are areas neuroplasticity and nervous-system regulation can help you work with.
Medical assessment and care remain important. Alongside them, re-origin brings together neuroplasticity education, brain-body practices, somatic tools, coaching and community.
re-origin does not diagnose or treat POTS and does not replace medical assessment or care.
Medical disclaimer
The information on this page is provided for educational purposes only. It is not intended to diagnose, treat, cure or prevent any condition and does not replace assessment, diagnosis or treatment from qualified healthcare professionals. Do not start, stop or change medication or treatment based on this page. Seek appropriate medical advice for new, severe, worsening or unexplained symptoms.
References
- Vernino S, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting — Part 1. Autonomic Neuroscience. 2021;235:102828. View source → View source
- Raj SR, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): Priorities for POTS care and research from a 2019 National Institutes of Health Expert Consensus Meeting — Part 2. Autonomic Neuroscience. 2021;235:102836. View source → View source
- National Institutes of Health. Understanding POTS. NIH News in Health. View source → View source
- 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. View source → View source
- Bryarly M, Phillips LT, Fu Q, Vernino S, Levine BD. Postural orthostatic tachycardia syndrome: JACC focus seminar. Journal of the American College of Cardiology. 2019;73(10):1207–1228. View source → View source
- Raj SR. Postural tachycardia syndrome (POTS). Circulation. 2013;127(23):2336–2342. View source → View source
- Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clinical Autonomic Research. 2011;21(2):69–72. View source → View source
- National Heart, Lung, and Blood Institute. Postural orthostatic tachycardia syndrome (POTS). View source → View source