Have you ever stood up quickly and felt dizzy or lightheaded? For most people, this sensation is temporary and quickly resolves. But for those living with Postural Orthostatic Tachycardia Syndrome (POTS), it's just one of many strange and unexpected symptoms they may experience on a daily basis – if any of these resonate with you, it could be a sign to check in with your doctor. 

POTS is a complex and often misunderstood condition is a form of dysautonomia, a condition characterised by dysfunction of the autonomic nervous system (ANS). The ANS regulates involuntary bodily functions such as heart rate, blood pressure, digestion, and temperature control. In POTS, there is a malfunction in the regulation of blood flow and heart rate, particularly when transitioning from lying down to standing up.

While rapid heartbeat and dizziness are well-known symptoms of POTS, the condition can manifest in a myriad of other ways, some of which may seem bizarre or unrelated to heart function. From gastrointestinal disturbances to temperature regulation issues, the symptoms of POTS can vary widely from person to person, making diagnosis and management challenging for both patients and healthcare providers.

POTS is more common in women than men, and it often begins during adolescence or early adulthood. Estimates suggest that POTS affects approximately 1 to 3 million people in the United States alone, though many cases may go undiagnosed or misdiagnosed due to a lack of awareness and understanding of the condition. Here in Australia, some experts say the rate of POTS could be 1 in 100 for women – the problem lies in delayed diagnoses and misunderstandings around the disease and its presentation.

Diagnosis of POTS typically involves a thorough medical history, physical examination, and specialised tests such as a tilt table test to assess changes in heart rate and blood pressure upon standing – it seems straightforward, but as we’ll be unpacking below, not everyone presents in the same ways and doctors, in many cases, don’t suspect POTS.  We’ll explore some of the lesser-known symptoms of POTS and shed light on the experiences of those living with this often-perplexing condition – but first, let’s take a look at the more stereotypical symptoms:

Dizziness and Lightheadedness: Individuals with POTS often experience dizziness or lightheadedness upon standing up from a lying or seated position. This symptom is known as orthostatic intolerance and is typically accompanied by a rapid heartbeat.

Fatigue: Chronic fatigue is a prevalent symptom of POTS and can significantly impact daily functioning. Individuals may feel excessively tired or weak, especially after standing or engaging in physical activity.

Palpitations: People with POTS may experience heart palpitations, which are sensations of a rapid, pounding, or irregular heartbeat. Palpitations can occur during periods of increased heart rate, such as when standing up, and may be accompanied by other symptoms like chest discomfort or shortness of breath.

Fainting or Near-Fainting Episodes: Individuals with POTS may experience episodes of syncope (fainting) or near-fainting, particularly when changing positions suddenly. These episodes often occur due to a drop in blood pressure upon standing, leading to reduced blood flow to the brain.

Exercise Intolerance: Individuals with POTS often experience exercise intolerance, meaning they have difficulty engaging in physical activity without experiencing excessive fatigue, dizziness, or lightheadedness. This can significantly impact their ability to participate in daily activities and exercise routines.

Temperature Dysregulation: Dysautonomia, including POTS, can disrupt the body's ability to regulate temperature properly. As a result, individuals with POTS may experience symptoms such as excessive sweating, heat intolerance, or cold extremities. Fluctuations in body temperature can occur even in response to minor changes in the environment.

Sleep Disturbances: Many individuals with POTS experience sleep disturbances, including insomnia, disrupted sleep patterns, or non-restorative sleep. These sleep problems may be due to autonomic dysfunction, pain, anxiety, or other factors associated with the condition. Poor sleep quality can worsen other symptoms of POTS and impact overall wellbeing. 

It's important to note that POTS can vary widely in its presentation and severity among individuals, and additional symptoms may include brain fog, headaches, nausea, sweating, and difficulty concentrating. Remember, if you suspect you may have POTS, check in with your doctor first as many conditions have crossover symptoms and Dr. Google, while highly informative, isn’t always known for its nuance!

Now let’s dive into 3 symptoms that aren’t often associated with POTS – but are still reported in high numbers among patients. 

Gastrointestinal Issues 

POTS can manifest with a variety of gastrointestinal symptoms, including nausea, abdominal pain, bloating, constipation, or diarrhoea. Autonomic dysfunction can affect the normal functioning of the digestive system, leading to motility issues and discomfort after eating. Some individuals with POTS may also experience symptoms of gastroparesis, a condition characterised by delayed stomach emptying.

Cognitive Dysfunction

Cognitive symptoms are common in individuals with POTS and may include difficulties with concentration, memory problems, brain fog, and mental fatigue. These cognitive impairments can significantly impact daily functioning, work performance, and academic achievement. While the exact mechanism is not fully understood, changes in cerebral blood flow and neurotransmitter imbalances may contribute to cognitive dysfunction in POTS.

Sensory Sensitivities

Many individuals with POTS report heightened sensory sensitivities, such as increased sensitivity to light, sound, and touch. These sensitivities can exacerbate symptoms of dizziness, fatigue, and cognitive dysfunction, particularly in environments with excessive stimuli. Sensory overload may lead to feelings of overwhelm, anxiety, or physical discomfort, further impacting quality of life for individuals with POTS.

By recognising these less well-known symptoms of POTS, we can better identify and manage the condition, leading to improved symptom control and quality of life. It's important for individuals experiencing these symptoms to seek evaluation and support from healthcare professionals familiar with dysautonomia and related conditions. 

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