PoTS (Postural Tachycardia Syndrome) in Singapore: Symptoms, Causes and Treatment

Postural tachycardia syndrome (PoTS) is a condition in which the heart rate rises sharply and abnormally when you stand up, causing dizziness, palpitations and fatigue. It is a disorder of the autonomic nervous system – the automatic controls that keep blood pressure and heart rate steady as you change position – rather than a disease of the heart muscle itself. PoTS most often affects younger people, particularly women. If you have just come across this term, this page explains what PoTS is, its symptoms, how it is diagnosed with tilt-table testing, and how lifestyle measures and treatment can help. It is general information and not a substitute for advice from your own doctor.

What Is Postural Tachycardia Syndrome?

When you stand, gravity pulls blood down into your legs. Normally your body responds instantly – blood vessels tighten and the heart rate rises just a little – so blood keeps flowing to the brain. In PoTS this response is faulty: too much blood pools in the lower body, and the heart compensates by beating much faster than it should.

PoTS is defined by a sustained rise in heart rate of at least 30 beats per minute (or 40 beats per minute in teenagers) within ten minutes of standing, without a large drop in blood pressure, together with symptoms – and with other causes excluded. It is not a life-threatening rhythm problem like the ventricular arrhythmias, but it can be disabling. It commonly begins in the teens to forties and affects far more women than men.

PoTS Symptoms

Symptoms come on with standing and often ease on lying down:

• Palpitations – a racing or pounding heartbeat on standing
• Dizziness or light-headedness
• Fatigue, often profound
• Brain fog – difficulty concentrating or thinking clearly
• Near-fainting, and sometimes fainting (syncope)
• Headache, shakiness and sweating
• Nausea and other gut symptoms
• Poor exercise tolerance
• Symptoms that are worse in the morning, in the heat, after meals, or during menstruation

Singapore’s hot and humid climate can make symptoms worse, as heat encourages blood to pool and fluid to be lost through sweating.

Causes and Risk Factors

The exact cause is often unclear, and PoTS is usually the end result of several factors affecting the autonomic nervous system:

• Following a viral illness – symptoms often begin after an infection
• After a period of prolonged bed rest, surgery, pregnancy or significant weight loss
• Joint hypermobility and related connective tissue differences
• Autoimmune conditions in some people
• Being female and younger – the group most commonly affected
• Dehydration and low salt intake, which worsen blood pooling

PoTS is not caused by anxiety, although the physical symptoms can feel similar and the two often get confused.

How PoTS Is Diagnosed

Diagnosis involves confirming the heart rate response and ruling out other causes of a fast heart rate.

• Active stand test – your heart rate and blood pressure are measured lying down and then at intervals after standing, to document the rise.
• Tilt-table test – you are secured to a table that is tilted upright while your heart rate and blood pressure are monitored continuously; this reproduces the standing response in a controlled way and is a key test for PoTS.
• Electrocardiogram (ECG) – a resting electrocardiogram (ECG) checks the heart’s electrical activity and rules out other rhythm problems.
• 24-hour Holter monitor – a 24-hour Holter monitor records the heart during normal activity to link the fast rate to your symptoms and exclude an arrhythmia such as supraventricular tachycardia (SVT).
• Blood tests – to check for anaemia, thyroid problems and other conditions that cause a fast heart rate.
• Echocardiogram – an ultrasound scan of the heart, used in selected cases to confirm the heart’s structure is normal.

Treatment Options

Treatment focuses on lifestyle and self-management first, with medication added when needed. It usually needs to be tailored over time.

• Fluids and salt – drinking plenty of water (often around two to three litres a day) and increasing dietary salt, where your doctor agrees it is safe, help expand blood volume and reduce pooling. This is especially important in Singapore’s heat.
• Compression garments – waist-high compression stockings or abdominal binders reduce the pooling of blood in the legs and abdomen on standing.
• Graded exercise – a structured programme starting with seated or recumbent exercise (such as a recumbent bike, rowing or swimming) and building up gradually helps recondition the body; standing upright exercise too soon can be counterproductive.
• Simple physical measures – rising slowly, crossing the legs or tensing muscles when standing, raising the head of the bed, and avoiding long periods of standing or very hot environments.
• Medication – when lifestyle measures are not enough, drug classes that slow the heart rate or help the body retain fluid and tighten blood vessels may be used; these are chosen and monitored by a specialist.

Many people improve substantially over months to years, particularly younger patients, with consistent lifestyle management.

When to See a Cardiologist

See a cardiologist if you have persistent palpitations, dizziness or fainting on standing, or unexplained fatigue and brain fog that worsen when upright. It is important to confirm the diagnosis and rule out other rhythm problems before starting treatment. Our team managing heart rhythm disorders can arrange the appropriate tests and guide a management plan suited to you.

Frequently Asked Questions

Is PoTS a serious heart condition?

PoTS is not life-threatening and does not damage the heart, but it can be genuinely disabling, affecting work, study and daily activities. With diagnosis and consistent management, most people see meaningful improvement in their symptoms.

How is PoTS diagnosed?

The core finding is a sustained rise in heart rate of at least 30 beats per minute (40 in teenagers) within ten minutes of standing, with symptoms and without a big drop in blood pressure. A tilt-table test, ECG and Holter monitor help confirm it and rule out other causes.

Can PoTS go away on its own?

It can improve significantly over time, especially in younger people and when it follows a viral illness. Consistent lifestyle measures – fluids, salt, compression and graded exercise – are central to recovery, though some people need longer-term management.

Is PoTS the same as anxiety?

No, although they are often confused because both cause a racing heart, dizziness and shakiness. PoTS is a physical problem with the autonomic nervous system that produces a measurable heart rate rise on standing, and it is not caused by anxiety.

Does drinking more water and salt really help PoTS?

For many people, yes. Increasing fluids and salt (when your doctor agrees it is safe) expands blood volume and reduces the pooling that drives symptoms. This is a first-line measure and is especially important in Singapore’s hot, humid climate.