Postural tachycardia syndrome (PoTS) should be considered in the differential diagnosis of patients who present to a cardiology clinic for investigation of palpitations and syncope. Patients may present with symptoms of orthostatic intolerance including dizziness, fatigue, tiredness, syncope and pre-syncope and there is an associated tachycardia on standing. They are frequently misdiagnosed with anxiety, depression or chronic fatigue syndrome. PoTS is a type of dysautonomia, a dysfunction of the autonomic nervous system. To diagnose PoTS, a stand test or head-up tilt table test is performed. There should be a rise in heart rate from supine to upright position of greater than 30 beats per minute and often to higher than 120 beats per minute within 10 minutes of standing. The exact aetiology remains unclear and is currently the focus of much research. Management is challenging and incorporates a combination of non-pharmacological and pharmacological approaches resulting in improved quality of life for the sufferer.