Why Is Standing So Difficult for POTS Girls and Guys

During standing, POTS patients suffer from orthostatic intolerance, the occurrence of an assortment of bizarre symptoms when upright. When POTS patients are upright there is a reduction in the return of blood from the lower body to the heart and recirculated to the brain and other vital organs. When one assumes the up-right posture, gravity causes a shift in blood toward the lower limbs, placing a physiological challenge on the body’s ability to maintain normal return of blood to the heart via the veins. Normally, in healthy individuals, about 25% -30% of the body’s circulating blood is located in the mid-chest (heart and lungs). During standing upright, gravity will shift 2 – 3 cups of this blood from the mid-body into the pelvis and legs – about 1 cup into the pelvis and 2 cups into the legs. Most of this gravitational shift takes place almost immediately after standing.

The role of excessive venous pooling during standing has been confirmed by testing with radioactive tagged red blood cells. Radioactivity in the calf region has been compared within healthy individuals while lying down and standing upright. Investigators tag red blood cells (add radioactivity to red blood cells), re-inject them and measure their circulatory paths. In healthy individuals, immediately upon assuming an upright posture, radioactivity (measured from radioactive tagged red blood cells) within the calf increases greater than 2-fold. Among POTS patients, the radioactivity increases almost 3-fold upon standing upright. Thus, in POTS patients, even more blood may gravitate into the lower abdomen, pelvis, thighs and legs during standing upright.

This pooling was confirmed 70 years ago among non-POTS patients by measuring the pressure within the veins of the ankle during lying, sitting and standing. Venous pressure in the foot increased 5-fold when changing from lying to sitting and 8-fold after assuming a standing posture for 22 seconds. Walking on a treadmill resulted in a venous pressure of only 2-fold greater than during lying and one-quarter of that measured during standing (a 4-fold fall). Walking really does pump blood uphill.

All of these measurements confirm the important role of muscular contractions of the leg muscles in pumping blood upward. Because there is reduced return of blood to the heart when upright, there is a subsequent reduced volume of blood pumped with each subsequent heartbeat . Specifically, during standing in individuals with POTS, the cardiac output is significantly reduced. The more severe the reduction in cardiac output and cerebral blood flow, the greater the reduction in oxygenation of the brain and severity of symptoms.

Dr. Scheldon Kress is a specialist in Internal Medicine with over 30 years of clinical experience caring for patients and pioneering behavioral management strategies to help patients make healthy lifestyle changes with respect to weight loss, stress management, diabetes management and smoking cessation. Passionate about helping patients manage difficult to diagnose medical conditions, he became interested in POTS when several family members and friends struggled with the symptoms, proper diagnosis and effective management of POTS.

Observing the challenges of POTS first-hand, he began to provide POTS patients and their families with a better understanding of causes and potential treatments, while at the same time teaching them how to utilize an effective behavioral change program to manage their POTS symptoms. This self-directed program is a must-read for patients and families dealing with POTS to empower them to take back their lives and achieve POWER over POTS.

Five Star Reviews

Extremely helpful and informative

My daughter has been suffering these symptoms for months. She, like many others, has been misdiagnosed with neurological diseases and mental illness. Even with her heart rate being 30 beats different and multitude of symptoms, doctor was still skeptical because of her blood pressure not changing. Doctors are not educated on this syndrome and it’s extremely hard to find one that is. This has brought a lot of stress to our family, however, as her mom, I persevered, held my own and kept on researching. I came across POTS, educated myself and now we know what’s wrong and how to fix it. This book was one of the books to help us get there. Thank you for publishing this extremely helpful information!

- Praha2014, Amazon

I would like to thank Dr. Kress for writing this book and bringing much needed attention to this illness. POTS is something I have struggled with for many years and I appreciate how thorough and descriptive the book is. The first part of the book expertly describes the ins and outs of finding a diagnosis and how to recognize POTS in a patient. The second section of the book is perfect for families trying to navigate the lifestyle changes that a patient and the rest of the family go through in order to make recovery easier. The book covers all the bases for someone who is looking for more information about POTS. I will most definitely be sharing this book with friends and family and continue spreading the word of this most amazing book.

- Mary Beth, Amazon

The Best POTS Book Available!

This book was extremely helpful in helping my family understand and navigate POTS. The medical information is outstanding and the explanations for the behavioral changes necessary to improve POTS symptoms are easy to understand. I would recommend this book to anyone who is interested in learning more about POTS or wants to lessen their POTS symptoms to feel better. It really is a fantastic book and I like that it is written by a medical doctor who really understands how POTS affects every aspect of a patient's life.

- Angelina, Amazon

This book was incredibly helpful in educating me and helping me manage my child's difficult medical condition.

- Karen, Goodreads

Additional Information

I hope you find my book to provide helpful information on the subjects discussed. The book is not meant to be used, nor should it be used, to diagnose or treat any medical condition. For diagnosis or treatment of any medical problem, consult your own physician. The publisher and author are not responsible for any specific health needs that may require medical supervision and are not liable for any damages or negative consequences from any treatment, action, application or preparation, to any person reading or following the information in this book. References are provided for informational purposes only and do not constitute endorsement of any websites or other sources. Readers should be aware that the websites listed in this book may change. The author is no longer in private practice and not in a position to respond to any medical inquiries.