Pectus Excavatum and POTS: Is There a Link?

You stand up and your heart takes off. Your head goes light and you need to sit back down. Maybe a doctor called it anxiety, or someone online said POTS. Underneath sits one question: is my chest doing this?

I couldn’t find a study that measured how often pectus excavatum and POTS occur together. The research shows three real connections instead. The two can look alike. A severe chest can cause a fast heart rate or fainting by itself. And both turn up with connective tissue conditions, so they may share a cause. So rather than guessing, get the standing pattern measured and the chest assessed.

Worried right now? Skip to when to see a doctor. If your heart races mostly at rest or during exercise, read pectus excavatum and heart problems instead.

I was diagnosed with pectus excavatum at 15 and corrected it without surgery over about three years. The change was visible and measurable, but not complete. I’m not a doctor, so every medical point below comes from a named study or health service. New to the condition? Start with what pectus excavatum is.

Is there a link between pectus excavatum and POTS?

As of October 2026, I couldn’t find a study of how often people with pectus have POTS, or the reverse, or of any pectus treatment in people with POTS. Related research exists, and who it measured matters.

What was studied	Who	What it found	What it can’t tell you
Nervous-system response to sitting up (Taiwan pilot)	20 men with pectus, 14 without	Blunted, and more typical after the Nuss	Men only, sitting not standing, POTS not tested, before and after only
Symptoms before surgery (Mayo Clinic Arizona)	432 adults evaluated for surgery	67% dizzy on standing. In the 32 given an autonomic screen, that didn’t line up with the result	Referral group, small tested subgroup
Fast heart rate from compression (case report)	One woman, 65, Haller index 8.1	Settled after open repair	One person, not a POTS study
Fainting from compression (case reports)	Two young adults with severe chests	Fainting blamed on the chest pressing on the heart	Two people, not a POTS study
EDS and POTS (systematic review)	30 studies	Often occur together	About EDS, not pectus
Pectus in hypermobile EDS (survey)	3,360 people reporting hEDS	3.7% reported pectus	Self-reported, self-selected
Pectus and POTS together; pectus treatment in POTS	No study found	I couldn’t find a study	No data either way

An autonomic screen tests the nerves that run your heart rate and blood pressure automatically. A referral group is people sent to a surgeon, so it skews toward deep, symptomatic chests. The Mayo Arizona group’s median Haller index, a severity number from a chest scan where about 2.5 is average, was 4.2, and its first author discloses royalties from the maker of the Nuss bar.

My takeaway: standing dizziness is common in people seen for pectus surgery, but in that small tested group it didn’t track the autonomic result. So it isn’t automatically POTS. It isn’t automatically your chest either.

What POTS is

POTS stands for postural orthostatic tachycardia syndrome. Postural and orthostatic refer to standing up, and tachycardia means a heart rate over 100 beats a minute, says Cleveland Clinic. In POTS, the heart rate jumps when you stand and stays up, and symptoms ease lying down.

What doctors look for	Adults	Ages 12 to 19
Heart rate rise on standing or tilt, sustained, within 10 minutes	At least 30 beats a minute	At least 40 beats a minute
Blood pressure	No orthostatic hypotension	No orthostatic hypotension
Symptoms	On standing, for at least 3 months	On standing, for at least 3 months
Other causes	Ruled out	Ruled out

The table follows the 2026 international consensus and the 2021 NIH-led consensus. The 2015 Heart Rhythm Society statement uses the same heart-rate thresholds. The NIH-led review adds that POTS remains undefined under age 12. For younger children, see sunken chest in babies and children.

Orthostatic hypotension is a different problem: blood pressure drops when you stand. The NHS calls blood pressure low below 90/60.

US estimates run from 0.2% to 1% of people, though the NIH-led review says prevalence hasn’t been properly studied. POTS is far more common in girls and women, by more than 4 to 1, and often starts in the teens. It can follow a viral illness, an injury, pregnancy or surgery, and its causes are incompletely understood. For girls and women with a dip, see pectus excavatum in women and girls.

Many people improve over time, but plenty keep some symptoms, and long-term studies are thin, so I won’t give a figure. The Heart Rhythm Society statement reports no deaths from POTS itself, and Cleveland Clinic says the biggest physical risk is getting hurt in a fall when you faint.

Why pectus and POTS can look alike

Several main symptoms overlap, and the NHS says PoTS symptoms can resemble other conditions. The difference is mainly when they happen.

Symptom	With pectus	With POTS (NHS)
Dizziness or light-headedness	67% on standing, Mayo Arizona referral group	On standing, eases lying down
Palpitations or a racing heart	66% in that group; listed by Cleveland Clinic	On standing
Chest pain	Listed by Cleveland Clinic	On standing
Breathlessness	With exercise (Cleveland Clinic)	On standing
Fainting or nearly fainting	Rare, in case reports	On standing
Who has it more	Boys	Girls and women (NIH-led review)

Cleveland Clinic’s pectus excavatum page supplies its pectus entries and puts pectus at about 1 to 8 per 1,000 people, more common in boys.

The pattern is the clue. POTS shows up when you get up or stay upright, and eases lying down. Heart and breathing symptoms from the chest itself tend to show up with exercise, and the Mayo Arizona authors note that compression can worsen when sitting and leaning forward. Breathlessness has its own guide.

How a severe chest can raise your heart rate by itself

In a severe chest, the breastbone can press on the right side of the heart. Cleveland Clinic doctors reported a 65-year-old woman with years of palpitations and a fast heart rate that a high-dose beta blocker didn’t control. Her heart was filling poorly, and a scan showed a severe dip (Haller index 8.1) pressing on it. After open repair (a modified Ravitch), her palpitations went and her heart rate returned to normal. The report blames her chest and doesn’t describe POTS.

Fainting from compression is rare, but documented. Doctors blamed an 18-year-old woman’s faint in the shower on her breastbone pressing on her heart, together with iron-deficiency anemia. A 19-year-old fainted into a dangerous heart rhythm while bending forward. Both had severe chests.

My interpretation: a severe chest can leave the heart less room to fill, so it beats faster to keep up, mostly with effort or in certain positions. POTS is a standing pattern with its own causes. Nothing stops someone having both, so finding one doesn’t rule out the other.

The connective tissue connection

This thread has the most data behind it, but it runs through a third condition rather than from pectus to POTS. Hypermobile Ehlers-Danlos syndrome (hEDS) is a connective tissue condition in which joints bend further than usual.

• EDS and POTS often occur together. A 2026 systematic review of 30 studies found POTS in 17.5% to 92.7% of people with EDS, and EDS in 17.9% to 50% of people with POTS, depending on the population. One author discloses consulting for companies working in POTS. The NIH-led review says 20% to 30% of people with POTS meet the criteria for hEDS.
• Pectus is reported in hEDS, but it isn’t common. In a global online survey of 3,360 people reporting hEDS, 3.7% said they had pectus excavatum, against 0.1% in a large US comparison group. In the same survey, 52.7% reported POTS. People chose to take part, reported their own diagnoses and weren’t matched to the comparison group, so treat these as rough.
• Pectus can be a sign of a connective tissue condition. A 2013 review says pectus may appear on its own or as a sign of an underlying connective tissue disorder, and that ruling one out matters before surgery. More in my guide to the causes of pectus excavatum.

My interpretation: in some people, a connective tissue condition such as hEDS may sit behind both. That would make pectus and POTS show up together more often than chance, without one causing the other. I couldn’t find a study that tested this directly.

How to find out if it’s POTS

With a test that measures your heart rate and blood pressure lying down, then standing. Your chest needs its own assessment.

The stand test and the tilt test

The NIH-led review says POTS can usually be identified by recording heart rate and blood pressure lying down, then over 10 minutes of quiet standing. The NHS calls this an active stand test. Exact timings vary by clinic.

A tilt table test helps when a stand test isn’t enough or you can’t stand for 10 minutes. You lie strapped to a padded table that tilts up to about 70 degrees for up to 45 minutes while you’re monitored. Arrange a lift home. Cleveland Clinic calls tilt testing the main way to diagnose POTS; the NIH-led review says a stand test is usually enough. Expect either.

The basic work-up adds an ECG and blood tests (blood count, thyroid, electrolytes) to rule out other causes, such as dehydration, anemia, an overactive thyroid, medicines and anxiety. Anxiety is on that list as a real explanation, not a brush-off. If you’ve been told it’s anxiety, ask what ruled out the rest, and see pectus excavatum and anxiety.

What the chest side adds

A stand test won’t show whether your chest is pressing on your heart. That takes a chest scan, which gives your Haller index, and often an echocardiogram, an ultrasound of the heart. The NIH-led review’s basic work-up also includes an exam for signs of hEDS.

What to ask your doctor

• Can we do a 10-minute stand test, or do I need a tilt test?
• Should I have an ECG and blood tests? Could dehydration, low iron, my thyroid, a medicine or anxiety explain this?
• Could my chest be pressing on my heart? Do I need a scan for a Haller index, or an echocardiogram?
• I’m very flexible. Should I be checked for a connective tissue condition such as hEDS?
• Is it safe to start a vacuum bell, brace or exercise program?

What helps POTS

Your doctor sets the plan, which typically begins with education and non-drug treatment, the NIH-led review says. Here are the general steps it and the NHS describe.

• Triggers and fluids. The NHS lists heat, long periods upright, carbohydrate-heavy meals and alcohol as triggers, and says drink until your pee is pale.
• Salt, only if your doctor advises it. More salt is commonly advised, but the amount is your doctor’s call. PoTS UK says to ask first if you have heart or kidney disease or high blood pressure, and that there’s no evidence for the right amount in children, so ask a pediatrician. It also warns that websites confuse salt and sodium. So I give no number.
• Compression. Waist-high compression tights or an abdominal binder, per the NIH-led review.
• Exercise, started lying or seated. Rowing, a recumbent bike or swimming first, building toward upright. It can feel worse for up to six weeks, the NIH-led review says. In a Dallas study, 19 people with POTS completed a three-month program and 10 of them no longer met the criteria. Small, and the training had no comparison group.
• When you feel faint. The NHS says lie down and raise your legs. If you can’t, cross your legs, rock on your toes, or clench your buttocks, tummy and fists. Sit for a while before standing up.

There’s no FDA-approved medicine for POTS. Doctors sometimes prescribe fludrocortisone, beta blockers (which slow the heart), midodrine, pyridostigmine or ivabradine, case by case. The NIH-led review says the evidence for many of them is not robust, and the NHS says you may need to try several.

Exercising with both

My interpretation: if you have both, the POTS plan sets the order. Start lying or seated as your doctor advises, build up, and fit chest work around that. I couldn’t find a study of training in people with both, so this isn’t a protocol. Once your doctor clears you, my pectus excavatum exercises guide covers the chest side.

Will a vacuum bell or surgery help POTS?

I couldn’t find a study of either in people diagnosed with POTS. The only evidence is indirect: the Taiwan pilot in 20 men, and the single cases above, where repair ended a fast heart rate or fainting caused by compression.

The 2024 Pectus Care Guidelines, a consensus of specialist societies, say surgery is indicated in the rare cases of life-threatening compression, dangerous heart rhythms or fainting. That’s about the chest pressing on the heart, decided by a surgeon after testing. More in pectus excavatum surgery.

Can surgery cause POTS? Surgery is one of the general triggers the NIH-led review and Cleveland Clinic list. I couldn’t find data on POTS starting after pectus surgery specifically.

For the bell, a Basel center’s review lists cardiac disorders among its contraindications and does an ECG and an echocardiogram before anyone starts. That’s one center’s routine; others may differ. More in vacuum bell therapy.

My rule: unexplained symptoms on standing get assessed before any bell, brace or program.

When to see a doctor

See a doctor before you start any device, brace or exercise program if any of these apply to you:

• chest pain
• fainting or nearly fainting
• breathlessness at rest or with light effort
• palpitations or an irregular heartbeat
• a diagnosed heart or lung condition
• Marfan syndrome or Ehlers-Danlos syndrome, or a doctor has raised either
• previous chest surgery
• a Haller index above 3.25 together with symptoms
• symptoms that nobody has checked yet

None of these means you’ll need surgery. They mean someone should look at your heart and lungs before you go further. An index above 3.25 is a common referral threshold, not an emergency.

Call 911 (999 in the UK) or your local emergency number now if you have any of these. Don’t drive yourself.

• palpitations that won’t stop
• palpitations with chest pain, shortness of breath, feeling faint or fainting
• sudden chest pain or pressure that doesn’t go away
• chest pain that spreads to your arm, neck, jaw or back
• chest pain with sweating, feeling sick, light-headedness or breathlessness

That list follows the NHS advice on chest pain and palpitations, as in my heart problems guide.

The NHS fainting advice adds calling 999 if someone fainted while exercising or lying down, can’t be woken, isn’t recovering, has a seizure or is badly hurt. Fainting during exercise or lying down isn’t the typical POTS pattern, which is why it belongs on this list.

Who to see. Start with your family doctor. If they find something, or your chest is severe and you have symptoms, ask for a referral to a pediatric or thoracic (chest) surgeon who works with chest wall conditions.

What to do next

Pick the line that sounds like you.

• Symptoms on standing that nobody has measured. See a doctor and ask for the stand test, or use the 911 list if it fits.
• Diagnosed with POTS, wondering about your chest. Ask whether your chest could be adding to it. Hold off on any bell, brace or program until your doctor says it’s safe.
• Very bendy, or EDS has been raised. Doctor first, before any device or program.
• Cleared by a doctor and wondering about your chest. For a sense of how significant yours is and which route fits, take my free 1-minute quiz.
• Parent of a child under 12. POTS isn’t defined at that age, so take the symptoms to your pediatrician.

Give it honest time. Finding the right POTS plan can take a while, and structural change in the chest without surgery is measured in months and years.

Sources

1. Hsu YT, et al. J Cardiothorac Surg. 2022;17(1):89. Read it
2. Jaroszewski DE, et al. J Thorac Dis. 2024;16(12):8565-81. Read it
3. Postural Orthostatic Tachycardia Syndrome (POTS). Cleveland Clinic. Updated 2026 Jun 8 [cited 2026 Oct 21]. Read it
4. Sivakoti K, et al. Am J Med. 2026 Aug 28 (online ahead of print). Read it
5. Vernino S, et al. Auton Neurosci. 2021;235:102828. Read it
6. Sheldon RS, et al. Heart Rhythm. 2015;12(6):e41-63. Read it
7. Low blood pressure (hypotension). NHS. [cited 2026 Oct 21]. Read it
8. Postural tachycardia syndrome (PoTS). NHS. Reviewed 2026 Jul 22 [cited 2026 Oct 21]. Read it
9. Pectus Excavatum. Cleveland Clinic. [cited 2026 Oct 21]. Read it
10. Alkhatib R, et al. JACC Case Rep. 2026;31(39):108778. Read it
11. Christensen MJ, Foti J. Clin Pract Cases Emerg Med. 2026;10(1):81-4. Read it
12. Moossdorff M, et al. Eur Heart J Case Rep. 2021;5(10):ytab373. Read it
13. Kwok CS, et al. Auton Neurosci. 2026;267:103453. Read it
14. Daylor V, et al. J Clin Med. 2025;14(16):5636. Read it
15. Tocchioni F, et al. Pediatr Rep. 2013;5(3):e15. Read it
16. Tilt Table Test. Cleveland Clinic. Updated 2026 Apr 13 [cited 2026 Oct 21]. Read it
17. Diet and fluids. PoTS UK. [cited 2026 Oct 21]. Read it
18. Incorrect information on internet regarding salt/sodium intake. PoTS UK. 2026 Jun 16 [cited 2026 Oct 21]. Read it
19. Fu Q, et al. J Am Coll Cardiol. 2010;55(25):2858-68. Read it
20. Dunning J, et al. Pectus Care Guidelines. Eur J Cardiothorac Surg. 2024;66(1):ezae166. Read it
21. Haecker FM, Sesia S. J Vis Surg. 2016;2:63. Read it
22. Chest pain. NHS. [cited 2026 Oct 21]. Read it
23. Fainting. NHS. Reviewed 2026 Aug 17 [cited 2026 Oct 21]. Read it