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Lightheaded heart racing

POTS: Lightheadedness and a racing heart

Editor's note: First in a two-part series on postural orthostatic tachycardia syndrome (POTS). Click here for part two.

This past February, a 57-year-old firefighter came to my cardiology clinic after experiencing a strange set of symptoms. A few weeks earlier, he had gotten COVID-19. Predictably, he lost his sense of smell, developed a low-grade fever, and experienced muscle aches. Within a week his COVID-19 symptoms were gone, but he continued to feel off. And the new symptoms he described — sudden lightheadedness when standing up and an unusually fast heartbeat — made me suspect a condition called postural orthostatic tachycardia syndrome, or POTS.

Below I’ll explain what’s known so far about the triggers and hallmark symptoms of POTS. In a later post, I’ll discuss diagnosis and treatment.

What is POTS?

POTS is a syndrome, which means it’s a collection of symptoms and medical findings that often cluster together. The hallmark of POTS is bothersome symptoms that occur when standing upright. The medical term for these symptoms is orthostatic intolerance.

Most commonly, people report

  • lightheadedness or dizziness with standing (fainting may occur in more severe cases)
  • fatigue
  • shakiness
  • difficulty concentrating (also called brain fog)
  • palpitations (a sense of rapid, pounding, or irregular heartbeat).

People who have POTS also often experience headaches, digestive problems like bloating and constipation, insomnia, heat intolerance, and difficulty exercising due to shortness of breath and fatigue.

Who gets POTS?

POTS most often affects women between the ages of 15 and 50. However, it has recently been diagnosed in other groups of people following infection with COVID-19. People who have long COVID (sometimes called long haulers) may develop several different types of symptoms affecting various organs including the brain, lungs, and kidneys. One subtype of long COVID is POTS.

What is known about recovery?

Research suggests about half of people diagnosed with POTS will recover or improve over a period of a few years.

However, for others, a vicious cycle can develop if POTS goes untreated. The cycle begins because people start to spend more time in bed, avoiding activities that provoke symptoms. As people become far less active, muscle mass in the legs is lost, heart capacity shrinks, and the volume of circulating blood is reduced. These changes make standing upright even more uncomfortable, leading to yet more time spent in bed.

Over time, some people stuck in this cycle can become disabled. They’re unable to perform daily household tasks without becoming dizzy and exhausted. Many take time off from school or work.

What causes POTS?

The underlying cause of POTS is not yet known. It often follows a period of bedrest after an injury such as a concussion, surgery, or a viral illness like mononucleosis or the flu. More recently, POTS has been diagnosed in some people who have had COVID-19. Even after the acute infection resolves, these people may have lingering fatigue, lightheadedness, and a rapid heart rate when upright.

Many researchers suspect that POTS may be an autoimmune disorder, caused by the body’s immune system becoming overzealous. When this happens, the immune system correctly targets the intruding virus but mistakenly targets the body’s own healthy tissues, causing unwanted damage. In the case of POTS, this damage is thought to affect the lining of the blood vessels, which lose their ability to tighten, or constrict, in response to standing upright.

Three clues: Lightheadedness, changes in heart rate, and the effects of gravity

Before our firefighter, whom I’ll call David, became sick, he kept track of his heart rate on his smartwatch. It was typically about 60 to 70 beats per minute (bpm) at rest. Now, however, his resting heart rate was in the 80s and spiked into the 130s after one flight of stairs. Merely standing up caused lightheadedness and a racing heartbeat. He could no longer get through his usual spin class. He stopped taking hot showers because they made him feel dizzy.

While most of us take for granted the simple act of standing upright, a person with POTS may find it extremely uncomfortable. Why does POTS cause orthostatic intolerance? It helps to first understand the normal response to standing:

  • Gravity causes about one-third of blood volume to instantly pool below the waist.
  • Less blood returns to the heart, so less blood is then pumped out to the body.
  • This leads to a drop in blood pressure to the brain (have you ever experienced a short-lived sense of lightheadedness or "seeing stars" when jumping up quickly after sitting for a long period of time?).
  • The drop in blood pressure is detected by sensors in the heart.
  • These sensors activate the sympathetic nervous system (SNS), instructing the adrenal glands to release an adrenaline-like substance called norepinephrine into the bloodstream to help solve the problem.

How norepinephrine affects the body

Norepinephrine signals the heart to beat more rapidly and forcefully, restoring normal blood flow to the brain. It also signals the blood vessels to tighten, which drives blood to return to the heart instead of pooling in the lower half of the body. Within a few seconds of standing, blood pressure is restored to normal.

However, for reasons not fully understood, this signal is ineffective in POTS, and the blood vessels do not tighten in response to norepinephrine. More blood remains in the lower body, so that less returns to the heart, and therefore less is pumped out to vital tissues and organs. To maintain normal blood pressure, the heart beats faster to compensate for the lower volume of blood pumped with each contraction of the heart.

An overactive flight-or-fight response?

Thousands of years ago, evolution favored those who responded to the stress of physical danger by producing high levels of norepinephrine, allowing them to fight off an attack or run from harm. By releasing norepinephrine into the bloodstream, the nervous system primes virtually every organ for physical activity and potential injury. The pupils dilate; digestion slows; the heart beats quickly. This has been dubbed the fight-or-flight response.

Norepinephrine levels measured in the blood of people who have POTS are significantly higher than in those who do not, leading to an excessively fast heart rate and often a strong, pounding heartbeat. In addition to these effects on the heart, elevated norepinephrine levels can target other organs including the digestive system, causing abdominal bloating and constipation.

If you often experience the symptoms described in this post, you may want to ask your doctor to check you for POTS. A later post will discuss diagnosis, treatment, and living with POTS.

Follow me on Twitter @daraleelewismd

Heart Rhythm Disorders |

Millions of people experience irregular or abnormal heartbeats, called arrhythmias, at some point in their lives. Most of the time, they are harmless and happen in healthy people free of heart disease. However, some abnormal heart rhythms can be serious or even deadly. Having other types of heart disease can also increase the risk of arrhythmias.

Heart rhythm disorders can be divided into three broad categories, electrical, circulatory, and structural. Cardiologists are physicians who diagnose and treat disorders of the heart. Electrophysiology is a subspecialty branch of cardiology. An electrophysiologist (EP) is highly trained in the management of electrical properties of the heart, and is the most knowledgeable doctor to deal with the many often complex options for treating heart beat, or heart rhythm, disorders.


Abnormal heart rhythms (arrhythmias) are caused by problems with the electrical system that regulates the steady heartbeat. The heart rate may be too slow or too fast; it may stay steady or become chaotic (irregular and disorganized). Some arrhythmias are very dangerous and cause sudden cardiac death, while others may be bothersome but not life threatening.

Learn More


High Blood Pressure and coronary artery disease (causing blockages in the pipes (arteries) that supply blood to the heart) are the main causes of blood vessel disorders. They can result in a stroke or heart attack, which can be devastating. Fortunately, there are many preventative and treatment options.

Learn More


Heart muscle disease (cardiomyopathy) and congenital abnormalities (problems in the development of the heart and blood vessels which are present from birth) are two problems that can damage the heart muscle or valves.

Learn More

Pediatrics and Congenital Heart Disease

This section is for pediatric patients and families living with heart rhythm disorders and heart rhythm disorders related to congenital heart disease (CHD).

Learn More


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More Questions?

Take this information with you to a physician that specializes in heart rhythm disorders by using our international specialist directory.

Find a Specialist

Assess Your AFib Risk

Atrial fibrillation (AFib) is the most common abnormal heart rhythm. In a normal heart, the four chambers of the heart beat in a steady, rhythmic pattern. With AFib, the atria (upper chambers of the heart) fibrillate (quiver or twitch quickly) and create an irregular rhythm.

Learn Your Risk for AFib

Pediatrics and Congenital Heart Disease (CHD)

This section is for pediatric patients and families living with heart rhythm disorders and heart rhythm disorders related to congenital heart disease (CHD).

Early Warning Signs

If you are experiencing a racing, pounding, rumbling or flopping feeling in your chest or if you have been fainting, having repeated dizzy spells, feeling lightheaded or you are extremely fatigued, it's time to see a doctor to discuss your heart health.

Common Treatments

Learning about the underlying cause of any heart rhythm disorder provides the basis for selecting the best treatment plan. Information and knowledge about care options, and their risks and benefits help you work with your health care provider to make the best choices.


Since other heart disorders increase the risk of developing abnormal heart rhythms, lifestyle changes often are recommended. Living a “heart healthy” lifestyle can ease the symptoms experienced with heart rhythm disorders and other heart disorders, and can be beneficial to overall patient health.

The Normal Heart

The heart is a fist-sized muscle that pumps blood through the body 24 hours a day, 365 days a year, without rest. The normal heart is made up of four parts: two atria on the top of the heart (right atrium and left atrium), and two ventricles (right ventricle and left ventricle) which are the muscular chambers on the bottom of the heart that provide the major power to pump blood.

Prevention of heart disease | GBUZ PC "October Central District Hospital"

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  • Prevention of heart disease

Why is heart disease prevention so important? Not only health, but also the life of a person directly depends on the state of the heart.

How the heart works

Basically, the heart is one big muscle called the myocardium. It works throughout a person's life, contracting rhythmically and pumping about five liters of blood per minute through the vessels.

The human heart has four chambers. The top two are called the atria, the bottom two are the ventricles. Venous blood is pumped through the right atrium and ventricle to the lungs, which has already delivered oxygen to the cells and taken away carbon dioxide from them.

And through the left half of the heart, arterial blood saturated in the lungs with oxygen goes on a journey through the body. The contraction of the ventricles, pushing out the blood, is the heartbeat.

What harms the heart

The heart is the hardest working and hardiest muscle in the body. But it can also be seriously affected if its owner treats his health too lightly.

Worst of all is the smoker's heart. After just a few puffs, it starts to wear out - carbon monoxide from tobacco smoke sharply reduces the concentration of oxygen in the blood, and it has to be distilled in large volumes in order to prevent the body from feeling oxygen deficient.

But at the same time, nicotine causes vasospasm, including those that feed the heart. As a result, the myocardium works in a forced mode and almost without food.

The same mechanism of wear and tear of the heart muscle triggers the intake of alcohol. The need to rid the body of its toxins increases the load on the heart, which is forced to drive poisoned blood at an increased speed.

Improper nutrition is very harmful to the heart. If there is too much fatty and sweet food in the daily diet, cholesterol plaques are gradually deposited in the vessels of the heart, which can lead to blockage of blood vessels and death of the heart muscle from a lack of oxygen.

In addition, lovers of junk food often lead a sedentary lifestyle, and it leads to a decrease in the fitness of the body, including the heart.

An unhealthy diet and lack of movement lead to excess weight, which puts even more stress on an already lazy heart.

How to keep a healthy heart until old age

There is no need to remind once again that it is better to drink and smoke and not start. But, if bad habits have already appeared, in order to maintain the working capacity of the heart, it is worth breaking up with them forever as soon as possible.

The heart muscle feels good when nutrition is not only balanced, but also rich in special "heart" vitamins A, C, E and B. Natural vegetable oils and fatty sea fish, rich in essential fatty acids Omega-3 and Omega-, are very good for the heart. 6.

Fruits, vegetables, nuts, and whole grains will not only provide the body with most of the important nutrients, but will also prevent weight gain.

But fatty meat, salinity and smoked meats should be excluded from the diet - they are considered provocateurs of heart disease due to the high content of saturated fats and salt.

Even the most lazy heart can be put in order with special exercises, which are called cardio workouts.

These are long-term, but simple loads that allow you to gradually, without overstrain, strengthen the heart muscle and make the heart work more productive.

The heart trains even on the way home or to work. To do this, it is enough to once again pass a couple of bus stops in a calm rhythm, walk up the stairs, breathing measuredly and avoiding a rapid heartbeat, or ride a few kilometers on a bicycle.

smoking and heart - GBUZ AO regional clinical anti -TB dispensary

Ministry of Health of the Astrakhan Region

GBUZ Center for Medical Prevention

Memo for the population

smoking and the heart

The heart - is the most industrious and enduring muscle in the body.

But it can also be seriously affected if its owner treats his health too lightly. One of the most negative influences on the activity of the heart is smoking.

People often smoke not so much because of the desire that has arisen, but because of the fashion that has appeared for smoking. It is believed that smoking relieves psycho-emotional stress. Potential illnesses and bad breath do not stop people - they still smoke.

But the smoker's heart is the worst. Did you know that smoking and cardiovascular disease are linked? Or that smoking raises blood pressure?

The heart of a smoker suffers as a result of constriction and damage to the structure of blood vessels. Oxygen starvation develops, which leads to a reduction in the life resource of the smoker. The heart begins to contract faster and requires more oxygen. The heart rate increases to 90 beats per minute.

What really happens to our body?

Smoking a cigarette causes a significant increase in blood pressure. With regular smoking, blood pressure is much higher than it could be in a non-smoker. With regular smoking, persistent arterial hypertension develops, in which blood pressure rises above 140/90 mm Hg. Getting into the blood with tobacco smoke, nicotine constricts blood vessels, thereby increasing blood pressure.

Smoking at high blood pressure significantly increases the risk of cardiovascular diseases up to 70 times (ischemic heart disease, myocardial infarction, stroke, etc.). With arterial hypertension, the vessels of the brain can be damaged (the walls of the vessels become weak, which significantly increases the risk of their rupture).

But as soon as smoking stops, ends and the effect of tobacco toxins on the body.

Among smokers, vascular and heart diseases are several times more common than among non-smokers. The risk of myocardial infarction increases in direct proportion to the number of cigarettes smoked."

Sometimes, when smoking, in some people, the number of heartbeats can suddenly reach up to 200 per minute, and this load does not go unnoticed.
A person who smokes a pack of cigarettes a day increases the load on the heart by 2 times, which leads to premature wear of the heart.

Under the influence of nicotine, the heart of a smoker can make how many thousands more contractions per day than that of a non-smoker. Nicotine can narrow blood vessels and increase the risk of atherosclerosis.

Smoking is especially dangerous for women and children. For example, women who smoke a pack of cigarettes a day are 6 times more likely to develop HEART DISEASE than those who have never smoked. And in men who smoke, they increase 3 times.

Smoking causes more than 80% of all deaths from coronary artery disease in men aged 35-44 years and 27% in men aged 45-64 years. A study of risk factors showed that smokers have a sharp increase in the risk of angina pectoris (2 times), myocardial infarction (2 times), coronary artery disease (2.2 times), sudden death (4.9 times).times).

Smokers are much more likely to die at a young age than non-smokers. Men under the age of 45 who smoke more than 25 cigarettes a day are 10 to 15 times more likely to die from acute heart attacks than non-smokers of the same age. The average age of people who died suddenly from heart attacks in non-smokers is 67 years, in smokers - 48 years. Nearly 20 years shortens his life, a man because of cigarettes. Smoke inhalers are also at greater risk, along with non-smoker smokers.

There is no need to remind once again that if bad habits have already appeared, in order to preserve the working capacity of the heart, it is worth breaking up with them forever as soon as possible.

Tips for those smokers who want to quit smoking:

  1. When you decide to quit smoking, think about what you get instead: health for yourself and your loved ones, saving money. Quitting smoking after 6 months will positively affect your health.
  2. Plan ahead for a quit date.
  3. Stop smoking immediately, without first trying to cut back on cigarettes or switch to "light" cigarettes.
  4. Try to avoid situations that provoke smoking, including the company of people who smoke.
  5. Reward yourself with something nice for every step you complete.
  6. Employment in interesting and useful work helps to overcome the desire to smoke.
  7. Do not be discouraged if there is a breakdown. With repeated attempts, the chances of success increase.
  8. Ask your doctor for help to fulfill your desire to quit smoking for medication support and to reduce withdrawal symptoms, follow his advice.
  9. It is desirable to prefer physical activity in the open air. The heart trains even on the way home or to work. It is enough to walk a couple of bus stops, walk up the stairs, breathing measuredly and avoiding a rapid heartbeat, or ride a few kilometers on a bicycle.

Advice to friends and family:

  1. Remind the smoker of the dangers of smoking for his health and for the health of those close to him.
  2. Never create a comfortable environment for smoking.
  3. Do not give a smoker nice "smoking" accessories (expensive cigarettes, lighters, ashtrays).

    Learn more

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