PoTS
Postural tachycardia syndrome, also known as postural orthostatic tachycardia syndrome (PoTS), is a condition that causes an abnormal increase in your heart rate after sitting up or standing up. The most common symptoms are feeling lightheaded or dizzy, palpitations (being aware of your heartbeat) and fatigue. Normally, when you sit up or stand up, gravity makes some of your blood flow downward
What it is
PoTS is a clinical syndrome rather than a single disease. Common associations include post-viral (including post-COVID), Ehlers-Danlos syndrome, mast cell activation, deconditioning and (rarely) autoimmune causes. Diagnosis is made by active stand or tilt-table test in a patient with characteristic symptoms — both available at The Vesey.
Symptoms and signs
- Light-headedness, palpitations or chest discomfort on standing — sometimes with near-syncope.
- Significant fatigue, often disabling, often described as worse on standing.
- Brain fog, poor concentration, reduced exercise tolerance.
- Gastrointestinal symptoms — bloating, nausea, irritable-bowel-like patterns.
- Symptom onset often within weeks of a viral illness, pregnancy, surgery or trauma.
How we investigate
12-lead ECG, active stand test (10 minutes), tilt-table test where active stand is inconclusive. Bloods include FBC, ferritin, B12, folate, thyroid, cortisol, autoimmune screen and (where indicated) tryptase. Echocardiogram and 24-hour Holter to exclude structural and arrhythmic causes.
Treatment options at The Vesey
- Lifestyle and rehabilitation — fluid (2–3 L/day), salt (10–12 g/day), compression garments and a structured graded exercise programme starting with recumbent exercise.
- Pharmacological options — beta-blockers, ivabradine, midodrine, fludrocortisone — selected by phenotype.
- Co-morbidity management — joint hypermobility / EDS support, mast cell management, GI symptom management.
- Multidisciplinary input — links to physiotherapy, dietetics and where needed psychology for the chronic-illness load.
- Structured follow-up — most patients improve substantially over 12–24 months; regular consultant review is part of that.
What is the difference between PoTS and simple fainting? +
Simple vasovagal syncope (fainting) is usually a brief one-off episode with a clear trigger (pain, heat, prolonged standing) and rapid full recovery. PoTS is a chronic syndrome causing persistent symptoms on standing every day — palpitations, light-headedness, fatigue and brain fog — without necessarily causing a blackout. The active stand test distinguishes them.
How is PoTS diagnosed at The Vesey? +
Diagnosis requires a heart rate rise of 30 bpm or more (40 bpm in under-20s) within 10 minutes of standing, without significant blood pressure drop, in the presence of characteristic symptoms. We perform the active stand test at the initial consultation and can arrange tilt-table testing for inconclusive cases.
Is PoTS related to long COVID? +
Post-COVID autonomic dysfunction is now the commonest identified trigger for new-onset PoTS in adults. The syndrome is identical in presentation to non-COVID PoTS and responds to the same management strategies. Recovery is possible but may take 12–24 months of structured rehabilitation.
Can PoTS be cured, or is it a permanent condition? +
Most patients improve substantially with the right management — fluid and salt loading, compression garments, graded exercise, and where necessary medication. A significant proportion achieve remission or near-remission over 1–3 years, particularly post-COVID and post-deconditioning presentations.
Pricing at a glance
Initial consultant cardiology consultation £290 (60-minute slot, includes ECG and active stand test). Tilt-table test from £550. Autonomic screening bloods from £290. 24-hour Holter from £290. Echocardiogram from £320. Insurance accepted: BUPA, Vitality, AXA, WPA, Cigna, Aviva, Healix.
Book an appointment
When to see a specialist
Book if you have had unexplained postural symptoms for more than 3 months, post-COVID autonomic symptoms that have not resolved, or if you have been told "your tests are normal" but standing reliably makes you feel awful.
Cost and pathway
Initial consultant cardiology consultation £290 (60-minute slot, includes ECG and active stand test). Tilt-table test from £550. Autonomic screening bloods from £290. 24-hour Holter from £290. Echocardiogram from £320.
- Open 7 days including Sundays — 8am to 8pm, no weekend surcharge
- No GP referral required — book directly with our consultant cardiology team
- Sutton Coldfield location — serving Birmingham, Walsall, Tamworth, Lichfield and the West Midlands
- CQC-regulated — rated 4.87/5 on Doctify from 700+ verified reviews
View our cardiology services →
Sutton Coldfield · Birmingham · Walsall · Tamworth · Lichfield · West Midlands · Open 7 days 8am–8pm
Open 7 days · 8am–8pm · 0121 387 3727