How is POTS Diagnosed?

Detailed questioning of the patient is the key to accurate diagnosis.  Physical examination and appropriate investigations are also important. Other causes of symptoms need to be considered and identified.

Patients are usually diagnosed by a cardiologist, neurologist or medicine for the elderly consultant.

To be given a diagnosis of POTS, a person needs to have:

• A sustained increase in heart rate of greater than 30 beats per minute within 10 minutes of standing
• Those aged 12-19 years require an increase of at least 40 beats per minute
• These criteria may not apply to those with a low heart rate when resting
• There is usually no drop in blood pressure on standing

Investigations

It may be necessary for patients to have some or all of the tests below.

Electrocardiography (ECG)

An ECG is performed to rule out any heart problems that may cause symptoms similar to those found in POTS.

The Active Stand Test

The active stand test can be used to diagnose PoTS. Under careful supervision, heart rate and blood pressure are measured after resting lying down, then immediately upon standing and after 2, 5 and 10 minutes. This test may bring on symptoms of PoTS and some people may faint.

Tilt Test

What are the symptoms of POTS?

Symptoms can be debilitating, ranging from mild to severe and varying from day to day.

POTS symptoms

• Dizziness or pre-syncope (almost fainting).
• Syncope (fainting).
• Palpitation (awareness of heartbeat).
• Headaches - orthostatic headaches (due to upright posture)/migraine.
• Brain fog (difficulty in thinking).
• Tiredness.
• Sense of anxiety.
• Shakiness.
• Visual problems (greying, tunnel or glare).
• Gut problems (nausea, diarrhoea, pain).
• Sweating.
• Chest pain.
• Poor sleep.
• Purplish discolouration of skin due to blood pooling in hands and feet.
• Bladder problems.

Triggers that can worsen POTS

• Excess heat.
• After eating - especially refined carbohydrate: sugar, white flour etc.
• Standing up quickly.
• Dehydration.
• Time of day (especially rising after wakening).
• Menstrual period.
• Deconditioning or prolonged bed rest.
• Alcohol (as it dilates blood vessels).
• Inappropriately excessive exercise.
• Temporarily during illness such as viral infections or after operations.*