POTS Explained by Doctors (What Actually Helps)
From Talking With Docs.
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Do you feel fine lying down, but dizzy, shaky and breathless every time you stand up? Does your heart race just from doing the dishes? That could be POTS, postural orthostatic tachycardia syndrome, and it's a lot more than a head rush.
In this episode of Talking With Docs, Dr. Brad Weening and Dr. Paul Zalzal are joined by Oakville general internist Dr. David Skogstad-Stubbs to talk about POTS: what it is, who gets it, how it's diagnosed, what has to be ruled out first, and what actually helps.
POTS is a problem with the autonomic nervous system, the "fight or flight" system that keeps blood flowing to your brain when you stand. When you get up, roughly half a litre to a litre of blood shifts down into your legs, and your blood vessels normally squeeze to push it back up. In POTS that response doesn't work properly, so the heart races to make up for it. It's most common in young women, often starting in the teens or early 20s, and since COVID, doctors have also been seeing men and older patients with POTS-type symptoms after long COVID.
Dr. Skogstad-Stubbs joined us before to talk about blood clots: https://youtu.be/ko8GTmaQEdU
You'll learn:
What POTS is, and why symptoms get worse standing and better lying down
Who gets POTS, and how long COVID has changed the picture
Why POTS isn't harmless: falls, missed school and work, and daily life
The diagnostic criteria: a sustained heart rate rise of 30+ beats per minute (40+ under 19), with symptoms
How the 10-minute NASA lean test works, and how you can track it at home with a smartwatch
The blood work to check first: hemoglobin, ferritin, thyroid and cortisol
Why a Holter monitor matters before calling it POTS
What "POTS plus" means: migraines, nausea, coat hanger pain and night symptoms
The POTS treatment mnemonic: Pressure, H2O, Training and Triggers (heat, alcohol), Salt
Why compression needs to reach your abdomen, not just your calves
How much fluid and salt doctors recommend, and why to front-load your fluids early in the day
How floor-based exercise, recumbent bikes and swimming retrain your adrenaline system
Why raising the head of your bed and crossing your legs can help
Which medications are used, including propranolol and ivabradine, and why they're symptom based
How ADHD medications and some antidepressants can cause POTS-like symptoms
Whether POTS gets better with time
The biggest message from Dr. Skogstad-Stubbs is that treatment starts without medication. Abdominal compression, around 3 litres of fluid a day, up to 10 grams of salt a day (about two teaspoons) and gradual exercise are the foundation. That much salt goes against the usual heart-health advice, so it isn't for everyone. If you have high blood pressure, heart disease or kidney disease, talk to your doctor first.
Exercise is part of the treatment, even when standing feels impossible. Start on the floor: pushing your feet against a wall, yoga, Pilates, a recumbent or stationary bike, or exercise in the water. It can take 4 to 6 weeks before you feel the benefit, so it's worth sticking with.
Medications can help when symptoms get in the way, but they ease symptoms rather than cure POTS. The goal is the smallest dose for the shortest time, as a bridge to the habits that make the long-term difference. And there's real hope: many people, especially young women, get better with time.
Do you have POTS? Share the strategy that has helped you most in the comments. It could help someone who was just diagnosed.
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🛑 DISCLAIMER: This content is for educational purposes only and should not replace professional medical advice. POTS affects people differently, and decisions about testing, salt and fluid intake, compression, exercise, and medications should be individualized based on your health history and circumstances. Increasing salt may not be safe if you have high blood pressure, heart disease or kidney disease. Always follow the guidance provided by your physician, pharmacist, and healthcare team. Full disclaimer at talkingwithdocs.com.
#POTS #POTSSyndrome #Dysautonomia #DizzyWhenStanding #OrthostaticIntolerance #LongCOVID #HeartRate #Tachycardia #AutonomicDysfunction #WomensHealth #POTSAwareness #TalkingWithDocs #DoctorExplains
Do you feel fine lying down, but dizzy, shaky and breathless every time you stand up? Does your heart race just from doing the dishes? That could be POTS, postural orthostatic tachycardia syndrome, and it's a lot more than a head rush.
In this episode of Talking With Docs, Dr. Brad Weening and Dr. Paul Zalzal are joined by Oakville general internist Dr. David Skogstad-Stubbs to talk about POTS: what it is, who gets it, how it's diagnosed, what has to be ruled out first, and what actually helps.
POTS is a problem with the autonomic nervous system, the "fight or flight" system that keeps blood flowing to your brain when you stand. When you get up, roughly half a litre to a litre of blood shifts down into your legs, and your blood vessels normally squeeze to push it back up. In POTS that response doesn't work properly, so the heart races to make up for it. It's most common in young women, often starting in the teens or early 20s, and since COVID, doctors have also been seeing men and older patients with POTS-type symptoms after long COVID.
Dr. Skogstad-Stubbs joined us before to talk about blood clots: https://youtu.be/ko8GTmaQEdU
You'll learn:
What POTS is, and why symptoms get worse standing and better lying down
Who gets POTS, and how long COVID has changed the picture
Why POTS isn't harmless: falls, missed school and work, and daily life
The diagnostic criteria: a sustained heart rate rise of 30+ beats per minute (40+ under 19), with symptoms
How the 10-minute NASA lean test works, and how you can track it at home with a smartwatch
The blood work to check first: hemoglobin, ferritin, thyroid and cortisol
Why a Holter monitor matters before calling it POTS
What "POTS plus" means: migraines, nausea, coat hanger pain and night symptoms
The POTS treatment mnemonic: Pressure, H2O, Training and Triggers (heat, alcohol), Salt
Why compression needs to reach your abdomen, not just your calves
How much fluid and salt doctors recommend, and why to front-load your fluids early in the day
How floor-based exercise, recumbent bikes and swimming retrain your adrenaline system
Why raising the head of your bed and crossing your legs can help
Which medications are used, including propranolol and ivabradine, and why they're symptom based
How ADHD medications and some antidepressants can cause POTS-like symptoms
Whether POTS gets better with time
The biggest message from Dr. Skogstad-Stubbs is that treatment starts without medication. Abdominal compression, around 3 litres of fluid a day, up to 10 grams of salt a day (about two teaspoons) and gradual exercise are the foundation. That much salt goes against the usual heart-health advice, so it isn't for everyone. If you have high blood pressure, heart disease or kidney disease, talk to your doctor first.
Exercise is part of the treatment, even when standing feels impossible. Start on the floor: pushing your feet against a wall, yoga, Pilates, a recumbent or stationary bike, or exercise in the water. It can take 4 to 6 weeks before you feel the benefit, so it's worth sticking with.
Medications can help when symptoms get in the way, but they ease symptoms rather than cure POTS. The goal is the smallest dose for the shortest time, as a bridge to the habits that make the long-term difference. And there's real hope: many people, especially young women, get better with time.
Do you have POTS? Share the strategy that has helped you most in the comments. It could help someone who was just diagnosed.
🎧 Listen on Your Favourite Platforms:
Spotify:
https://open.spotify.com/show/3OFxEjictC41CCS1z2AVKe
Apple Podcast:
https://podcasts.apple.com/ca/podcast/talking-with-docs-podcast/id1799242189
YouTube Music:
- TWD Podcast
👕 Shop Our MERCH:
https://www.spreadshirt.ca/shop/user/talking+with+docs
❤️ Support Oakville Hospital:
https://oakvillehospitalfoundation.com/
📱 Follow Us:
TikTok:
https://www.tiktok.com/@talkingwithdocs
Instagram:
https://www.instagram.com/talkingwithdocs/?hl=en
🛑 DISCLAIMER: This content is for educational purposes only and should not replace professional medical advice. POTS affects people differently, and decisions about testing, salt and fluid intake, compression, exercise, and medications should be individualized based on your health history and circumstances. Increasing salt may not be safe if you have high blood pressure, heart disease or kidney disease. Always follow the guidance provided by your physician, pharmacist, and healthcare team. Full disclaimer at talkingwithdocs.com.
#POTS #POTSSyndrome #Dysautonomia #DizzyWhenStanding #OrthostaticIntolerance #LongCOVID #HeartRate #Tachycardia #AutonomicDysfunction #WomensHealth #POTSAwareness #TalkingWithDocs #DoctorExplains
