Pots symptoms

We have had a lot of interest in POTS Postural Orthostatic Tachycardia Syndrome

(Dysautonomia) Autonomic Nervous System Disorder questions and concerns lately. Below are some of the symptoms that we suffer with in addition to Chiari.

Dysautonomia Information Network

POTS Place: A Guide to Postural Orthostatic Tachycardia Syndrome


Medical disclaimer


Postural Orthostatic Tachycardia is a syndrome. As such, there is a collection of symptoms that distinguish it. The symptoms are widespread because the autonomic nervous system plays an extensive role in regulating functions throughout the body. Many of these symptoms, such as low blood pressure,* may present only after prolonged standing. Symptoms will vary from person to person. The following is a list of symptoms reported by patients. When possible, we have included the percentage of patients that research reports have experienced a given symptom.

Symptoms presumed to be related to cerebral hypoperfusion:**

  • Lightheadedness 77.6 % (Grubb, 2000)
  • Fainting or near fainting 60.5% of patients report near fainting (Grubb, 2000)
  • Generalized weakness 50% (Low et al.)

Symptoms presumed to be related to autonomic overactivity include the following:**

  • Palpitations 75% (Grubb, 2000)
  • Tremulousness 37.5% (Low, Opffer-Gehrking, Textor, Benarroch, Shen, Schondorf, Suarez & Rummans, 1995)
  • Shortness of breath 27.6 % (Grubb, 2000)
  • Chest discomfort and/or pain 24.3 % (Grubb, 2000)

Sudomotor symptoms include the following:**

  • Loss of sweating 5.3 % (Low et al.)
  • Excessive sweating 9.2 % (Robertson, 2000)
    Loss of sweating and excessive sweating are more common in patients with elevated norepinephrine levels (Thieben, Sandroni, Sletten, Benrud-Larson, Fealey, Vernino, Lennon, Shen & Low, 2007).

Symptoms that may reflect dysautonomia:**

  • Delayed gastric emptying 23.7% of patients report gastrointestinal complaints, including bloating (Grubb et al., 1997)
  • Bloating after meals (Grubb et al., 1997)
  • Nausea 38.8% (Robertson, 2000)
  • Vomiting 8.6% (Thieben et al., 2007)
  • Abdominal pain 15.1% (Thieben et al., 2007)
  • Diarrhea 17.8% (Jacob & Biaggioni, 1999) (sometimes with alternating constipation)
  • Constipation 15.1% (Thieben et al., 2007)
  • Bladder dysfunction 9.2% (Thieben et al., 2007) (this may include Polyuria (Jacob & Biaggioni, 1999) (excessive urination)
  • Pupillary dysfunction 3.3% (Thieben et al., 2007) Pupillary dysfunction may or may not be responsible for some other reported symptoms, such as: Blurred Vision (Grubb, 2000) and Tunnel vision (Low et al.).

Generalized Complaint symptoms:**

  • Fatigue 48% (Grubb, 2000) (which can be disabling)
  • Sleep disorders 31.6% (Low et al.) (can cause unrefreshing sleep and an increased need for sleep)
  • Headache/migraine 27.6% (Grubb, 2000)
  • Myofascial pain 15.8% (Thieben et al., 2007) (characterized by regional muscle pain accompanied by trigger points)
  • Neuropathic pain 3% (Thieben et al., 2007)

Other symptoms reported in research that are not categorized above include:

  • Dizziness (Grubb, 2000)
  • Tachycardia (Grubb, 2000)
  • Exercise intolerance (Grubb, 2000)
  • Clamminess (Grubb, 2000)
  • Anxiety (Grubb, 2000)
  • Flushing (Grubb, 2000)
  • Postprandial hypotension (Grubb, 2000) (low blood pressure after meals)
  • Blood pooling in limbs (Grubb, 2000) (can make legs feel heavy and appear mottled and purple in color)
  • Intolerance to heat (Grubb & Karas, 1999)
  • Feeling cold all over (Grubb & Karas, 1999)
  • Low blood pressure upon standing (Grubb, Kosinski, Boehm & Kip, 1997) (Some physicians feel orthostatic hypotension is a separate entity from POTS)
  • Cognitive impairment (Grubb et al., 1997) (may include difficulties with concentration, brain fog, memory and/or word recall)
  • Narrowing of upright pulse pressure (Jacob & Biaggioni, 1999)
  • Cold hands (Low et al.) (and often feet & nose)
  • Hypovolemia (Low et al.) (low blood volume)
  • Chills (Low et al.)
  • High blood pressure (Low et al.)
  • Hyperventilation (Low et al.)
  • Numbness or tingling sensations (Low et al.)
  • Reduced pulse pressure upon standing (Low et al.)
  • Low back pain (Mathias, 2000)
  • Aching neck and shoulders (Mathias, 2000)
  • Noise sensitivity (Stewart, 2001)
  • Light Sensitivity (Stewart, 2001)
  • Disequalibrium (Sandroni, Opfer-Gehrking, McPhee & Low, 1999)

The above are symptoms reported by POTS researchers. Other symptoms sometimes reported by POTS patients include:

  • Arrhythmias (irregular heart beats)
  • Chemical sensitivities (May have multiple chemical sensitivity and can be very sensitive to medications - may only need small doses)
  • Easily over-stimulated
  • Feeling full quickly
  • Feeling "wired"
  • Food allergies/sensitivities (some foods seem to make symptoms worse)
  • Hyperreflexia
  • Irregular menstrual cycles
  • Loss of appetite
  • Loss of sex drive
  • Muscle aches and/or joint pains
  • Swollen nodules/lymph nodes
  • Polydipsia (excessive thirst)
  • Weight loss or gain
  • Feeling detached from surroundings
  • Restless leg syndrome

POTS symptoms can vary from day to day. They tend to multiply and become exaggerated upon upright posture. Blood flow and blood pressure regulation are also abnormal while supine or sitting, but these abnormalities may not be as apparent and may require orthostatic stress to become evident (Stewart & Erickson, 2002). Some patients do report symptoms occurring while sitting or lying down. Heat, exercise and eating can exacerbate symptoms. Women sometimes report an increase in symptoms around menstruation.

If you are suffering from some of the above symptoms, you need to seek professional help. Please do not attempt self-diagnosis.

*Some of the above symptoms are specifically related to orthostatic hypotension, traditionally defined as an excessive fall in BP (typically > 20/10 mm Hg) on assuming the upright posture. Not all patients will experience a drop in blood pressure upon standing. Some physicians define orthostatic hypotension as a separate entity from POTS.

** The hypothesized origin of symptoms and their frequency came from the "Postural Orthostatic Tachycardia Syndrome: The Mayo Clinic Experience" by Thieben, Sandroni, Sletten, Benrud-Larson, Fealey, Vernino, Lennon, Shen & Low, 2007.

Read more about POTS:

|| Overview || Mechanisms || Causes || Detection ||
|| What helps || What to Avoid || Myths || Research || Links


1. Grubb, B. P. (2000, July). Orthostatic intolerance. National Dysautonomia
Research Foundation Patient Conference. Minneapolis, Minnesota.
2. Grubb, B. P., & Karas, B. (1999) Clinical disorders of the autonomic nervous
system associated with orthostatic intolerance. Pacing and Clinical
Electrophysiology, 22, 798-810.
Full text: www.ndrf.org/PDF%20Files/disorders.PDF
3. Grubb, B. P., Kosinski, D.J., Boehm, K., & Kip, K. (1997). The postural
orthostatic tachycardia syndrome: a neurocardiogenic variant identified
during head-up tilttable testing. Pacing and Clinical Electrophysiology,
20, (9, Pt. 1), 2205-12. PMID: 9309745 [PubMed - indexed for MEDLINE]
4. Jacob, G., & Biaggioni I. (1999). Idiopathic orthostatic intolerance and postural
tachycardia syndromes. The American Journal of the Medical Sciences,
317, 88-101. PMID: 10037112 [PubMed - indexed for

Oh my gosh, thanks for posting this! I had heard the term "POTS" before but never had the chance to research it. I may take this to my doctor next week.

Thank you so much for sharing!
Katrina W.

Easy way to tell if you have pots is to do a poor mans tilt table test. Google this if your interested.

At the same time the only Neuro I could stand said this to me "We dont use that term in my office (POTS). Its the medical worlds way of acknowledging a problem but its vague and a garbage can type term like Fibromyalgia". My point is its just not the root cause. Yes its a problem but theirs got to be a root cause for this. Sorry if I'm outta line with this post.

In order to have pots you need to have the "Hallmark Symptom" which is an increased heart beat upon standing by at least 30 beats per minute AND continues to go up in a 10 minute time frame.

I had the tilt table test and been tested for Pots. I was first called borderline, then told no. Because my resting heart rate went from 76 to 90 to 104 to 112 then back to 96 during the ten minutes.

In the beginning when I was called borderline, I was told to treat it like POTS and for 6 weeks, increase my cardio, Salt intake, and core strength. If that doesn't help they will add in a med. something like propranolol/inderal in very small amounts. 10mg.

Needless to say I did not follow the salt intake thing, as I already knew more salt makes me worse.