Have you heard of postural tachycardia syndrome, more commonly called PoTS?
Several years ago, one of my younger patients was diagnosed after enduring months of severe dizzy episodes that made it impossible for her to remain standing. The symptoms appeared without warning and ultimately forced her to leave college.
That experience made me far more alert to PoTS and to how readily this often-overlooked condition can go undetected.
In some ways, that is hardly surprising. PoTS remains poorly understood, and many GPs may not have come across it during their medical training. Dizziness is also an extremely common complaint, yet pinpointing its cause can be remarkably challenging.
There are dozens of potential reasons for feeling dizzy, including dehydration, low blood pressure, anaemia, medication side effects and inner-ear conditions. In some cases, no clear explanation emerges.
However, PoTS should be considered, especially when dizziness, a racing heartbeat or a faint feeling starts after standing and eases once you sit down or lie flat.
If those symptoms sound familiar, it is worth raising the possibility of PoTS with your GP. Growing numbers of people, particularly women, are now receiving a diagnosis, making awareness of the condition important for both patients and doctors.
Dizziness is among the symptoms of postural tachycardia syndrome, also known as PoTS
PoTS affects the autonomic nervous system, which regulates bodily processes that happen without conscious control, including sweating, digestion, heart rate and blood-pressure changes.
For people with PoTS, standing causes the heart rate to increase abnormally. This can lead to dizziness, weakness, a pounding or racing heartbeat and, for some, fainting.
Sufferers can also experience extreme fatigue, headaches, brain fog, digestive problems and changes in sweating.
There is a simple test that can help flag whether it might be the cause. Your heart rate and blood pressure can be measured while you are lying down and then repeatedly after you stand up. In adults with PoTS, the heart rate typically rises by at least 30 beats per minute within ten minutes of standing, without the significant fall in blood pressure seen in some other conditions.
A smartwatch can provide useful clues, too. I’ve had patients show me readings demonstrating that their heart rate suddenly shoots up when they stand. Another clue can be unusually flexible joints.
If you are diagnosed, there are things you can do to make a real difference. One of the most important is surprisingly simple: fluids.
People with PoTS are advised to drink about two to three litres a day, which helps to maintain blood pressure. Increasing salt intake can also do this, but that isn’t something anyone should do without 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. None is currently specifically licensed in the UK for treating PoTS, so they 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.
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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 can be lifesaving for older adults who are more prone to developing deadly blood clots and strokes than young people.
But many doctors are still reluctant to prescribe them to older patients out of fear that their increased risk of falling will lead to more brain bleeds.
But studies have shown this worry is based on myth – a patient would have to fall hundreds of times a year for the risk of bleeding to outweigh that of stroke.
I’d love to hear from readers about your experience 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 build-up 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 forming and reduce the risk of further attacks. If you’re taking allopurinol but are still suffering gout, ask your GP 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 GP 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