Klinik Mehlsen

Postural Orthostatic Tachycardia Syndrome (POTS)

POTS is a condition which significantly reduces the ability of daily chores and reduces the quality of life. The term refers to the occurrence of symptoms in the upright position (postural - orthostatic) and is accompanied by high heart rate (tachycardia). Normally, the volume of the vascular system and the amount of fluid in the bloodstream are in a careful balance. With such a balance, only minor adjustments are needed to maintain an adequate blood pressure in standing position to ensure the perfusion of the brain. If the balance changes and the filling of the heart is critically reduced, it must be faster to maintain blood pressure at a sufficient level. When the heart beats faster, the filling time gets shorter and a vicious circle can be created where the increased heart rate leads to an even lesser filling of the heart and thus to an unstable blood pressure control. The activation of the autonomic nervous system for these adjustments most likely trigger the symptoms that are characteristic of POTS,


It is a diagnostic requirement for postural tachycardia that the heart rate increases by more than 30 beats when transitioning from lying to standing position (40 stroke at age under 18 years). Postural tachycardia alone can have many causes; eg. most people can develop the condition in the combination of warm weather and low fluid and salt intake or after a prolonged bedrest. In these cases, however, this deconditioning can easily be corrected by sufficient liquid and salt intake. POTS, on the other hand, is a state in which the heart rate increases in the upright position accompanied by a number of other symptoms that can not be eliminated by improving the fluid balance alone. Many of the symptoms are similar to those seen in CFS/ME.


The clinic offers assessment of symptoms as well as individual treatment in order to obtain recovery. The diagnosis requires measurement of heart rate and blood pressure on a beat by beat basis in the supine and standing position with a special equipment and in the case of recurrent syncope of a tilt table. We use medical treatment, rehabilitation - predominantly in a lying position - and dietary guidelines and advice on dietary supplements. In addition, we also provide advice on how to adjust daily activities.

The first consultation is expected to last up to 1½ hours. Further studies may be needed to evaluate heart rate and blood pressure control as well as the need and indication for medical treatment. Following visits are expected to last approximately ½ hour and can be carried out using encrypted SKYPE.