POTS

Postural orthostatic tachycardia syndrome (POTS) means your heart races when you stand up, with dizziness, fatigue, "brain fog", palpitations or nausea that ease when you lie down. Most common in young women, and can start after a viral illness, surgery or pregnancy. It is diagnosed by a heart rate rise of at least 30 beats per minute (40 in teenagers) within 10 minutes of standing, without a drop in blood pressure. Most people improve with treatment.

Treatment options

Ratings show how strong the research is.

• Moderate evidenceFluidsAim for 2 to 3 litres a day. Drinking 2 glasses of water quickly before getting up can ease morning symptoms.
• Moderate evidenceMore salt, if suitableExtra salt helps your body hold fluid. Your doctor will advise how much. Not suitable if you have high blood pressure, or heart or kidney disease.
• Moderate evidenceCompression garmentsWaist-high medical-grade stockings or an abdominal binder stop blood pooling in the legs and belly.
• Moderate evidenceGradual exerciseStart lying or sitting (recumbent bike, rowing, swimming) and slowly build up over months. Symptoms may worsen at first, then improve. An exercise physiologist or physio can help.
• Limited evidenceMedicinesSuch as low-dose propranolol, ivabradine, fludrocortisone, midodrine or pyridostigmine, chosen by your GP or a specialist when other measures aren’t enough. None is specifically approved for POTS in Australia.
• Not recommendedResting in bedLying down a lot leads to deconditioning, which makes POTS worse.

What you can do

• Get up slowly: sit on the edge of the bed for a minute first.
• If symptoms start, cross your legs, squeeze your thighs and buttocks, or sit or lie down.
• Avoid hot showers (or sit to wash), hot weather, big carbohydrate meals and alcohol.
• Keep a regular sleep routine, and pace your activities on bad days.

See your GP if

• You get dizzy or your heart races every time you stand
• Symptoms stop you working, studying or exercising
• You take medicines that may worsen symptoms, such as some blood pressure tablets or antidepressants

Call 000 if you faint during exercise, faint with chest pain or palpitations, or have chest pain or trouble breathing.

Evidence and more information

• Healthdirect: POTS
• Dysautonomia International: POTS treatment essentials
• Metro North Health: POTS management for GPs

Reviewed October 2026. General education, not personal medical advice. Treatment depends on your situation, so talk to your GP or pharmacist.

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