POTS and SVT can look similar because both involve tachycardia and overlapping symptoms, but they occur for different reasons. In cases of intermittent arrhythmias, it’s possible for an SVT to go undiagnosed and misattributed to POTS. Treating SVT does not treat POTS itself, but it could reduce overlapping symptoms.
Postural Orthostatic Tachycardia Syndrome (POTS) and Supraventricular Tachycardia (SVT) are distinct conditions that can share similar clinical presentations.
Both conditions involve a faster than normal heart rate, as well as palpitations, fatigue, and lightheadedness, but through fundamentally different mechanisms. In some cases, both conditions can coexist, and an underlying arrhythmia can be overlooked in patients initially thought to have POTS.
POTS
POTS is a form of orthostatic intolerance – symptoms occur when moving to an upright position and tend to improve when lying down. It is one of the most common forms of orthostatic intolerance, particularly in women. Estimates on the number of people affected range from about 500,000 to over 3 million.1-3
A defining feature is a heart rate increase of more than 30 beats per minute within 10 minutes of standing in adults (≥40 bpm increase in kids), without a significant drop in blood pressure. Any combination of dizziness, fainting (syncope), palpitations, fatigue, weakness, sleep disturbances, exercise intolerance, cognitive difficulties such as trouble concentrating, visual changes, shortness of breath, and gastrointestinal symptoms are commonly associated with POTS.
The tachycardia seen in POTS is sinus tachycardia. It originates from normal electrical signaling in the sinoatrial node, the heart’s natural pacemaker, but is exaggerated due to autonomic imbalance. In other words, it is a fast heart rate triggered by a dysfunction of the autonomic nervous system in response to standing up, but resting heart rate is usually normal when lying down. The exact cause is not fully understood, though emerging evidence suggests possible immune-mediated mechanisms.4-5
Since the root cause is as yet unknown, treating POTS is focused on symptom management and improving blood circulation. Increasing fluid and salt intake expands blood volume to keep blood pressure stable, and compression garments aid blood flow by applying pressure to the lower limbs. Since exercise intolerance is also a part of POTS, reclined or low-impact aerobic exercise can improve tolerance to standing. Medications are not always first-line, but can be used when lifestyle measures are not sufficient to address blood volume, vascular tone, or heart rate.
Because tachycardia is expected in POTS, intermittent SVT could be overlooked.5 Overlapping symptoms like palpitations and dizziness also make it difficult to distinguish between the two without further evaluation.
SVT
SVT actually refers to a group of arrhythmias caused by abnormal electrical pathways or reentry circuits. Episodes are characterized by a sudden onset and termination of rapid heart rate, which is different from the gradual, position-dependent tachycardia seen in POTS.
SVT involves a very fast or irregular heartbeat, with a heart rate upwards of 150 to 220 beats per minute, that begins and ends suddenly and originates in the upper chambers of the heart. The abnormal rhythm is caused by disrupted electrical signaling in the heart, and symptoms are wide-ranging: palpitations, chest discomfort or pain, dizziness, lightheadedness, shortness of breath, sweating, weakness, and fainting or near-fainting (syncope). However, some individuals don’t experience any symptoms (asymptomatic) and won’t require treatment.
Vagal maneuvers stimulate the vagus nerve and are used to regulate the heart rate for acute or sporadic episodes. Medications, cardioversion (resets electrical signals), or catheter ablation (destroys tissue that triggers arrhythmia) are treatment options when symptoms become frequent or prolonged, and initial management strategies are not helping. In rare cases, pacemakers might be considered, but they aren’t standard treatment for SVT.
Diagnostic evaluation might involve a single test or a combination of electrocardiograms (ECG), remote monitoring with Holter monitors or event recorders, and electrophysiological studies to detect or rule out abnormal electrical pathways. Symptoms that occur while lying flat, symptoms unrelated to position, and episodes that begin and end suddenly are also clues that suggest an arrhythmia is unassociated with POTS.
But sometimes people experience both conditions. Distinguishing between a positional (orthostatic) cause of tachycardia and an electrical arrhythmia can be challenging when symptoms overlap or when an underlying arrhythmia is intermittent.
The sympathetic nervous system (“fight or flight”) is persistently activated in POTS; heightened sympathetic activity is thought to promote abnormal electrical activity in the heart , and it’s possible that being in that state could increase susceptibility to arrhythmias.5
It’s also been observed that identifying and treating an underlying SVT could have a downstream effect in improving symptoms previously attributed to POTS, particularly palpitations and episodic tachycardia.5
Lifestyle Management
As with symptoms, managing either or both with lifestyle choices also overlaps. Triggers for both POTS and SVT include smoking, alcohol, and caffeine, and both can benefit from a heart-healthy diet.
Where lifestyle management deviates is in the underlying goal. For POTS, dietary strategies are aimed at improving circulation and reducing orthostatic symptoms. Staying properly hydrated and increasing salt intake (as long as hypertension or other salt-affected conditions are not present) helps regulate blood volume and pressure. After eating, blood is redirected to the digestive system, so eating smaller, more frequent meals can help reduce postprandial (after-meal) drops in blood pressure. Under medical guidance, an elimination diet can help identify personal triggers, such as gluten, dairy, or caffeine; some patient-reported data suggests a gluten-free diet could reduce symptoms in certain individuals.6
For SVT, lifestyle management is less about modifying circulation and more about avoiding things that provoke abnormal electrical activity, like stimulant-containing substances.
Interestingly, emerging research suggests a connection between gut health and the heart’s electrical signaling.7 Researchers have proposed that when the gut microbiome is disrupted, it can lead to a cascade of inflammatory signaling that can worsen an arrhythmia. (You can read more about that here.) Incorporating gut-friendly foods (e.g., fiber and yogurt with live cultures) might help mitigate those factors and improve heart health as well as its electrical rhythm, although research is still evolving and this is not yet part of standard SVT management.
Exercise, even with an arrhythmia (SVT) or dysautonomia (POTS), is still necessary for overall health, and it’s best to talk with your doctor about the types of physical activity that will count toward staying healthy without triggering tachycardia. Gradual progression is appropriate for both conditions, and seated or reclined activities will improve orthostatic tolerance over time.
Management of both conditions requires an individualized approach with proper medical guidance, and treatments that help one condition may not always be appropriate for the other. Be sure to communicate all medications, including vitamins and supplements, with your provider. Some medications, including over-the-counter products, have the potential to aggravate symptoms or could interact with each other in detrimental ways.
Dr. Andrea Tordini is a board-certified cardiac electrophysiologist with specialized fellowship training in diagnosing and treating abnormal heart rhythms.
Dr. Tordini is a part of Florida Medical Clinic Orlando Health
References
- Nesheiwat, Z., Towheed, A., Eid, J., Tomcho, J., Shastri, P., Oostra, C., Karabin, B., & Grubb, B. (2021). Supraventricular Tachycardia and Postural Orthostatic Tachycardia Syndrome Overlap: A Retrospective Study. The Journal of innovations in cardiac rhythm management, 12(2), 4385–4389. https://doi.org/10.19102/icrm.2021.120201.
- Dysautonomia International. (2019). 10 Facts Doctors Should Know About POTS. Www.dysautonomiainternational.org. https://www.dysautonomiainternational.org/page.php?ID=180.
- Safavi-Naeini, P., & Razavi, M. (2020). Postural Orthostatic Tachycardia Syndrome. Texas Heart Institute journal, 47(1), 57–59. https://doi.org/10.14503/THIJ-19-7060.
- National Institute of Neurological Disorders and Stroke. (2023). Postural Tachycardia Syndrome (POTS). Www.ninds.nih.gov. https://www.ninds.nih.gov/health-information/disorders/postural-tachycardia-syndrome-pots.
- Nesheiwat, Z., Towheed, A., Eid, J., Tomcho, J., Shastri, P., Oostra, C., Karabin, B., & Grubb, B. (2021). Supraventricular Tachycardia and Postural Orthostatic Tachycardia Syndrome Overlap: A Retrospective Study. The Journal of innovations in cardiac rhythm management, 12(2), 4385–4389. https://doi.org/10.19102/icrm.2021.120201.
- Standing Up To POTS. (2026). Lifestyle Modifications To Be Recommended By Practitioners Before or With Medication. Standinguptopots.org. https://www.standinguptopots.org/POTSlifestylemodifications.
- Gawałko, M., Agbaedeng, T. A., Saljic, A., Müller, D. N., Wilck, N., Schnabel, R. B., Penders, J., Rienstra, M., Van Gelder, I., Jespersen, T., Schotten, U., Crijns, H. J. G. M., Kalman, J. M., Sanders, P., Nattel, S., Dobrev, D., & Linz, D. (2022). Gut microbiota, dysbiosis and atrial fibrillation. Arrhythmogenic mechanisms and potential clinical implications. Cardiovascular Research, 118(11), 2415–2427. https://doi.org/10.1093/cvr/cvab292.
