From the Research
Yes, POTS (Postural Orthostatic Tachycardia Syndrome) can cause a visible line on the legs, known as venous pooling, due to blood pooling in the lower extremities caused by gravity and poor circulation. This occurs because POTS affects the autonomic nervous system, which controls blood vessel constriction, leading to inadequate blood flow back to the heart when standing, as noted in a study published in 2024 1. The pathophysiology of POTS is complex and multifactorial, involving impaired sympathetically mediated vasoconstriction, excessive sympathetic drive, volume dysregulation, and deconditioning, as discussed in a literature review published in the journal Current Problems in Cardiology 1.
To manage this symptom, several strategies can be employed:
- Compression stockings (20-30 mmHg or higher) to help prevent blood pooling
- Increased fluid and salt intake to maintain blood volume
- Physical countermaneuvers like muscle tensing and regular reclined exercise
- Avoiding prolonged standing
These management strategies are supported by recent studies, including a 2021 review that highlights the importance of lifestyle modifications and pharmacologic therapies tailored to the individual's POTS phenotype 1. While the evidence for specific treatments is still evolving, the use of compression stockings and increased fluid intake is widely recommended as a first-line approach to reduce venous pooling and alleviate symptoms associated with POTS, as discussed in a 2021 expert consensus meeting summary published in Autonomic Neuroscience 2.
Given the complexity and heterogeneity of POTS, a comprehensive approach to management that addresses the underlying pathophysiology and incorporates patient education, non-pharmacologic interventions, and targeted pharmacologic therapies is essential for improving outcomes and quality of life for individuals with POTS, as emphasized in a study published in the Journal of Cardiovascular Electrophysiology 3.