What's in this guide
1. Understanding your condition
Postural Orthostatic Tachycardia Syndrome (POTS) and other forms of dysautonomia affect the autonomic nervous system — the part of your body that automatically manages heart rate, blood pressure, digestion and temperature.
When you stand, your body normally adjusts blood flow almost instantly. With dysautonomia, that response can be delayed or exaggerated, leading to symptoms such as:
- Racing heart
- Dizziness
- Fatigue
- Brain fog
- Nausea
- Symptoms triggered by standing, heat, meals or stress
The PACE Dysautonomia Program focuses on practical strategies including fluids and salt, compression, gradual movement, breathing practice and daily tracking, alongside any medication prescribed by your physician.
2. HeartAge+
Track your symptoms. Understand your progress.
HeartAge+ helps you and your care team monitor symptoms, track progress and better understand how your body responds to daily activities and treatment.
Your daily check-ins and weekly stand tests help identify patterns that may be difficult to notice from day to day.
Through the HeartAge+ Dysautonomia Pathway, you can:
- Log symptoms and fluid/salt intake
- Track exercise and breathing practice
- Complete weekly stand tests
- Complete questionnaires
- Stay connected with your coach through Messages
HeartAge+ is available on web and mobile.
3. Fluids & salt
Increasing blood volume is one of the most important parts of managing dysautonomia. Fluids and salt can help your body maintain the circulation it needs when you are upright.
Fluids
Aim for at least 2.5 litres (2,500 mL) per day, and up to 3 litres on days when you have symptoms, unless your care team has provided a different target.
Water, broth and electrolyte drinks all count. Try to spread your fluid intake throughout the day rather than drinking a large amount at once.
Some people also benefit from drinking 500 mL of cold water first thing in the morning or before a known trigger such as a shower, prolonged standing or a meal.
Salt
Your care team will provide your individual daily salt target. A common target is 7–12 grams of salt per day, including food and any salt tablets.
Remember: 1 gram of salt ≈ 400 mg of sodium, so 7–12 grams of salt is approximately 2,800–4,800 mg of sodium.
4. Compression garments
Compression helps move blood from your legs and abdomen back toward your heart and brain. This can reduce dizziness and the increase in heart rate that can happen when standing.
For best results
Choose waist-high compression
Waist-high compression with abdominal support generally works better than knee-high socks alone. An abdominal binder may also be helpful.
Use medical-grade strength
Medical-grade compression of 30–40 mmHg is typically the most effective option.
Put them on before getting out of bed
Put compression garments on before you get up, while you are still lying down.
Get the right fit
Proper fit is important for comfort and effectiveness.
Your care team can recommend or prescribe compression garments and help you find an appropriate medical supply provider.
5. Movement & reconditioning
Deconditioning can make dysautonomia symptoms worse. The PACE reconditioning plan is designed to rebuild tolerance gradually and safely.
Exercise often begins in a seated or lying-down position before progressing to upright activity. Examples include:
- Recumbent cycling
- Rowing
- Swimming
Consistency matters more than intensity
Short, regular sessions are generally more helpful than occasional long or difficult workouts.
Progress only when you are completing most sessions and feel back to your usual baseline the following day.
Everyday movement tips
Avoid standing completely still for long periods. If you need to stand, try:
- Shifting your weight
- Rising onto your toes
- Marching gently in place
When standing from a seated or lying position, move slowly and tense your leg and glute muscles first.
6. Breathing & stress management
Slow, paced breathing can help calm an overactive “fight or flight” response, which is often heightened in dysautonomia.
Aim for 10 minutes, twice a day. Practice every day, not only when symptoms are present.
If you use a heart-rate strap or Skiin pod, the Find My Pace tool in HeartAge+ can help determine your personalized breathing rate. Without a device, choose a comfortable pace between 4.5 and 6.5 breaths per minute.
The Relax and Meditate features in HeartAge+ can also help with stress management, but they do not replace your regular coherence breathing practice.
7. Sleep
Good sleep habits can help support autonomic health. Try to:
- Keep a consistent sleep and wake schedule
- Limit long daytime naps if they interfere with nighttime sleep
- Raise the head of your bed 4–8 inches (10–20 cm) using blocks, risers or a wedge if recommended
8. Medication
Some patients may also need medication. Take all medication exactly as prescribed.
9. Common everyday triggers
| Trigger | What helps |
|---|---|
| Heat & hot showers | Try lukewarm showers, a shower stool, fans and cool cloths. Avoid hot tubs and saunas. |
| Large meals | Smaller, more frequent meals may be easier to tolerate. Limiting refined carbohydrates may also help reduce post-meal symptoms. |
| Alcohol | Alcohol can widen blood vessels and worsen dehydration. It is best avoided. If you do drink, keep it to two drinks per week or fewer, and avoid alcohol on days when you have symptoms. |
| Caffeine | Caffeine affects people differently. Stick with the amount that works for you, and avoid caffeine on the day of your stand test. |
| Prolonged bed rest | Extended bed rest can worsen deconditioning. When possible, continue gentle recumbent movement even on difficult days. |
| Early morning | Symptoms are often worse when you first wake up. Try hydrating before getting out of bed, putting on compression garments while still in bed and standing slowly in stages. |
| Menstrual cycle, illness & dehydration | Symptoms may flare during illness or around your menstrual cycle. Increase fluids — and salt if it is part of your plan — and reduce activity as needed. |
10. When to contact your PACE care team
- Any fainting or loss of consciousness
- Chest pain with exercise that has settled
- A racing heart that will not settle
- Symptoms that are clearly worsening despite following your plan
- A sudden decline in your condition
- Difficulty keeping fluids or food down
- Signs of dehydration you cannot correct with your usual routine
- Medication side effects
- A significant “crash” after activity
If you have fainted, do not drive until you have spoken with your care team.
11. When to call 911
- Chest pain
- Trouble breathing
- Fainting with an injury or blow to the head
- Fainting during exercise
- Fainting without warning
- Not waking within a minute or two after fainting
- Confusion after fainting
- New weakness or numbness
- Difficulty speaking
- Facial drooping
- A racing heart accompanied by chest pain, fainting or shortness of breath
If you are in distress or thinking about suicide, call or text 9-8-8 at any time. In an emergency, call 911.
12. Your daily checklist
Small, consistent habits can make a meaningful difference. Use this checklist alongside your HeartAge+ daily check-ins.
- Fluids throughout the day according to your target
- Salt as recommended by your care team
- Compression garments before getting out of bed
- Reconditioning or movement session
- Coherence breathing — 10 minutes, twice daily
- Consistent wake and sleep times
- Head of bed raised 4–8 inches
- HeartAge+ check-in
Contact PACE Cardiology
PACE Cardiology
602-581 Davis Dr
Newmarket, ON L3Y 2P6
T: 905-953-7917
F: 905-953-0046
E: info@pace-cardiology.com