Postural tachycardia syndrome, known as PoTS, is a poorly understood condition leaving increasing numbers of people, particularly women, with dizzy spells, brain fog and digestive problems, often undiagnosed for months, according to Dr Ellie Cannon, the GP who writes a health column for the Mail on Sunday.
Dr Ellie Cannon said a young patient of hers was diagnosed with PoTS a few years ago after months of dreadful dizzy spells that left her unable to stand up. The condition came on seemingly out of nowhere and forced her to drop out of college.
She said she has since become far more aware of PoTS and how easily it can be missed, adding that many GPs would simply never have encountered the condition during their training because it remains so poorly understood.
Dizziness is an extremely common symptom with dozens of possible causes, Dr Ellie Cannon said, ranging from dehydration and low blood pressure to anaemia, medication side effects and problems with the inner ear, which can make identifying the cause extraordinarily difficult.
PoTS deserves to be part of that list, she said, particularly when the dizziness, a racing heart or a feeling of faintness comes on when standing up and improves when sitting or lying down. Anyone who recognises that pattern should mention PoTS to their GP.
What is PoTS?
PoTS is a problem with the autonomic nervous system, the part of the body that controls functions people do not consciously think about, such as sweating, digestion and changes in heart rate and blood pressure.
In people with PoTS, the heart rate rises abnormally when they stand up. This can trigger dizziness, a pounding or racing heart, weakness and, in some cases, fainting. Sufferers can also experience extreme fatigue, headaches, brain fog, digestive problems and changes in sweating.
A simple test can help flag whether PoTS might be the cause of someone's symptoms, Dr Ellie Cannon said. Heart rate and blood pressure are measured while lying down and then repeatedly after standing up. In adults with PoTS, the heart rate typically rises by at least 30 beats per minute within ten minutes of standing, without the significant fall in blood pressure seen in some other conditions.
A smartwatch can also provide useful clues, she said, describing patients who have shown her readings demonstrating that their heart rate suddenly shoots up when they stand. Unusually flexible joints can be another clue.
Treating PoTS
People diagnosed with PoTS are advised to drink about two to three litres of fluid a day to help maintain blood pressure, Dr Ellie Cannon said. Increasing salt intake can also help, though she said this should never be done without medical advice.
Compression garments can reduce the amount of blood that pools in the lower body, meaning the heart does not have to work as hard to keep blood circulating.
Specialists can prescribe medication if these measures are not enough. None is currently licensed specifically in the UK for treating PoTS, so drugs are prescribed off-label and treatment has to be tailored to each patient. Some work by slowing the heart rate, while others help increase blood pressure or blood volume. Finding the right treatment can take time, and access to PoTS specialists remains patchy, Dr Ellie Cannon said.
Joan Branson inquest
Dr Ellie Cannon also addressed the inquest finding that the death of Joan Branson, wife of Virgin Group founder Sir Richard Branson, could have been prevented had doctors prescribed anti-clotting medication sooner. Joan Branson died in hospital in November 2025 at the age of 80.
Anticoagulants, also known as blood thinners, can be lifesaving for older adults, who are more prone than younger people to developing deadly blood clots and strokes. But Dr Ellie Cannon said many doctors remain reluctant to prescribe them to older patients, fearing that an increased risk of falling will lead to more brain bleeds.
She said studies have shown this concern is based on myth, and that a patient would have to fall hundreds of times a year for the risk of bleeding to outweigh the risk of stroke. Dr Ellie Cannon asked readers to share their own experiences of taking blood thinners, both good and bad, by writing in.
Reader question: recurring gout
A 78-year-old reader wrote in to ask what to do about constant attacks of gout in the feet despite eating a healthy diet.
Dr Ellie Cannon explained that gout is a type of arthritis caused by a build-up in the blood of a substance called urate, which can form tiny crystals in and around the joints. It most commonly affects the big toe, causing sudden and often excruciating pain, heat, redness and swelling, though it can affect other joints too.
If gout keeps coming back, she said, two possibilities are worth considering. The first is that the urate level needs lowering further. People who suffer frequent attacks are usually offered urate-lowering treatment, most commonly a daily drug called allopurinol, with blood tests used to monitor urate levels and gradually increase the dose until it reaches a target low enough to prevent crystals forming.
Losing excess weight and cutting down on alcohol can also help, Dr Ellie Cannon said, though dietary changes alone are unlikely to be enough to control recurrent gout on their own.
The second possibility is that the diagnosis is wrong, since gout can sometimes be confused with other forms of arthritis. She said that if someone is suffering what they describe as almost constant gout despite treatment, their GP should reconsider whether the original diagnosis is correct.
One of the best ways to confirm gout is joint aspiration, in which a small sample of fluid is taken from a swollen joint using a needle and examined for urate crystals. Ultrasound, X-rays and, in some cases, CT scans can also help doctors identify what type of arthritis is causing the problem.
