POTS (Postural Orthostatic Tachycardia Syndrome) is associated with a wide array of symptoms; therefore, the diagnosis of POTS is often complicated. Much of a POTS diagnosis is centered around ruling out other causes of POTS symptoms. Below are some of the tests that may be performed as part of an attempt to identify and diagnose POTS.
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Standing Test
The symptom of orthostasis is dizziness upon standing, and tachycardia is increase in heart rate. So orthostatic tachycardia is the intolerance to standing due to symptoms of dizziness with a fast heart rate.
This test is exactly what it sounds like. The patient stands up straight, for up to half an hour. The heart rate and blood pressure is monitored to assess the body’s response to standing. Blood tests are taken at the same time through an IV inserted usually in to the arm.
POTS patients will typically have an increase in heart rate by at least 30 beats per minute. There is usually no significant drop in blood pressure. Some patients will have elevated blood levels of certain hormones or blood transmitters. This can help differentiate between some of the different forms of POTS.
Tilt Table Test
Tilt testing is done to see if being held upright provokes the symptoms of POTS syndrome, such as a fall in blood pressure, an increase in heart rate, dizziness, or even passing out.
Adults are more likely to undergo this test then children, as many feel that the results of the test will not alter treatment and also that in children POTS may not necessarily give a positive test result (Batra et al).
The patient is secured/strapped straight flat on a table by seatbelt like devices then subjected to various angles of tilting. So 90 degrees would be being held straight upright. The usual angle used is 60-80 degrees, so not quite straight up. The test may go on for up to an hour.
POTS patients will typically have an increase in heart rate of >30 beats per minute in response to the tilt testing. There may also be a wide variety of symptoms experienced. In POTS there is not usually a significant drop in blood pressure. Blood tests, heart monitoring and other tests are typically performed during the test. Tilt table testing is considered generally safe, and medical staff will monitor throughout the test.
Heart Rhythm Testing
Tests to assess the heart rhythm are normally performed as part of a POTS diagnosis. An EKG is performed to see if there is a normal resting heart rhythm. Heart monitoring devices, such as a holter monitor may be worn over a 24 hour period (sometimes longer) to assess for possible heart rhythm problems that my cause symptoms such as palpitations.
Heart Function Testing
An echocardiogram may be performed to assess the structure and function of the heart. This will help to ensure a normal pumping function of the heart and to rule out the presence of valvular and other disorders. During the POTS diagnosis, the doctor may find the patients has a smaller heart than usual. (But, the pumping function is typically normal.)
Blood Tests
Multiple blood tests are performed when diagnosing POTS. A large number of these are to rule out other causes of symptoms, or to rule out conditions that can be associated with POTS. These include thyroid testing, B12, Vitamin D, certain hormone and enzyme level testing, and testing for autoimmune conditions such as lupus. Urine tests may also be done. Blood tests for levels of stimulatory nerve transmitters may be performed also to help differentiate between the different types of POTS.
QSART (Quantitative Sudomotor Axon Reflex Testing)
POTS falls under the umbrella of dysautonomias, and is a form of autonomic dysfunction. QSART is a kind of sweat test that tests the ability to increase sweat production appropriately and also to differentiate between different forms of sweating abnormality. The sweat glands respond to signals from the sympathetic nerves that lead to release of a transmitter called acetylcholine and leads to stimulation of sweat production. The QSART test can differentiate whether the abnormality is in the nerve signal or in the release of the transmitter.
Brain Imaging
Sometimes imaging is performed of the brain in order to rule out other underlying conditions associated with similar symptoms to POTS. That being said, there are no expected abnormalities in this imaging expected in a POTS patient. CT scan, especially in younger patients are often avoided due to the risk of radiation exposure. MRI scans are therefore often preferred when diagnosing POTS and have the advantage of higher resolution imaging for brain structure, and sometimes IV contrast is given to allow evaluation of the blood vessel supply also.
Summary of 7 Primary Ways to Test for POTS
How to diagnose 4 years old girl who also has chari malformations 1 and microcephyly and is constantly tired.
How are you feeling now – I have it too
I am 33 and have a chair malformation and I also was just diagnosed with pots. I honestly think the two are related and something is interfering with the vagus nerve and the vagus nerve controls most pots symptoms
Hi Holly. Why do you say that the vagus nerve is involved? I don’t know anything about the vagus nerve but am looking for help for a family member who almost passes out when she raises up from bending over. She’s not real compliant with support hose. Will take the salt and liquids. They want to do a table tilt test but I don’t know why when they proved it with standing and taking BP. Did you have the tilt table test? Since she is on so many meds I’m afraid of that test as the heart can stop! Thanks Holly. jaylynhushmail at gmail.
why kind of specialist do you see for this test?
Cardiologist or Electrophysiologist
My fiance has all the symptoms, but has passed almost all of these tests, his heart rate doesn’t speed up it drops suddenly…
I am 87. 9 months ago I noticed I was dizzy after coffee which I gave up. Dizzy after eating. I ate later in the day. In the beginning by 2 pm I wasn’t dizzy. This pattern turned to not dizzy till 8 pm. I have seen 4 doctors, mri of my brain ( I had DBS surgery in 08) If I sit for 2-3 hours dizzy goes away. When I stand and begin moving I get dizzy-dizzy. I have been doing exercises for vertigo and I’m still Dizzy.
I took care of my husband with Alzheimer’s for 12 years. Had double knee replacement. Published 2 books ..documenting Joe’s Alzheimer’s daily.
People who are out of shape can also have an increase in hr of 30 bpm upon standing. Apparently every out of shape person has POTS now.
This is an unhelpful comment. Not all out of shape people have POTS. (I don’t have POTS.) It is important to consider the list of symptoms and then get tested by a cardiologist or neurologist if it is a concern.
That’s a pretty big oversimplification of how POTS manifests in the body and how its diagnosed. The increase in heart rate is not the only marker. Obesity itself can be a primary cause of many overlapping issues as well. It sounds like you either didn’t read the article at all or haven’t been personally affected by things out of your control happening to your body.
Yes but out of shape people don’t get all of the POTS symptoms. If I stand for 30 sec my pulse goes up by 50 and I pass out if I stay standing for a few minutes. Unfit people can still walk around and sit watching tv. I can’t with POTS! However before I got this bad my pulse only rose by 30 and I could sit and stand but felt very weak and tired, if I was just unfit doing exercises would make me feel good not bad. Also I ended up with a spinal fluid leak and vertigo, this is not from being unfit. I also have EDS, this can cause POTS and my other symptoms too. Unfit people are usually well, they are just unfit and they don’t have the causes of POTS, instead they are just unconditioned. Having said that, the unfit person may have had a condition that caused them to be unconditioned which could trigger POTS in this case they had a cause.
Thank you for the incredibly helpful comment Samantha. I for one did not know that deconditioned individuals, like myself could get this because of that. That gives me hope that this can be remedied through exercise as opposed to a heart condition that there is no cure for, that most doctors haven’t a clue why it happens, that’s not easy to diagnose. Thank you.
Pots is dysatumonia, not a heart condition.
I lost over 1/2 of my 500 lb body with nutritional changes and lifpght exercise. This was all after a heart attack that killed off half my heart. Not proud but kinda am.
I don’t have an official diagnosis but from what I’m told it’s all but a forgone conclusion.
My symptoms seem to be getting much worse since my weight loss and the older I get. Neither is appealing to me.
I’m just trying to isolate th cause.
MONO when I was 4? and I’m a carrier. 2 weeks inpatient but I had a bunch of other stuff too strep, pneumonia, staff in my stomach, ear infection, you get the picture.
PNEUMONIA too many times from horrible allergies
GERMAN MEASLES
RUBELLA
MUMPS
CHICKEN POX
Some kind of autoimmune crap that nobody can figure out because it shouldn’t be able to flip between positive and negative but mine does, regularly.
Inflammation factors off the chart.
Sweating like a race horse that just won the Kentucky Derby. Along with this come arms and legs that turn to limp noodles. And I can barely sit upright. My heart races 30, 40, 50, beats faster than Normal and I can barely breathe. This has been occurring about a year and intensifying over time dramatically.
My vascular doc said it was anxiety or a panic attack.NO I DO NOT HAVE PANIC ATTACKS,!! I know what one looks like and is supposed to feel like that ain’t it.
I’ve been seen in thr ER twice and seen by a gastro doctor, they are certain my gallbladder is in the tank but when the scan or test it’s fine. But why is my stomach rejecting 90% of what goes in it? This has been going on 3 years.
At 15 I lost my dad from cancer and my untraceable migraines and seizures started within a month. EEGs , brain scans, and they found nothing(go ahead and giggle, I do I know my head is empty) However;my migraines and seizures continued. Until 2001 They stopped, cold, no explanation. Just stopped. Then 2015 I finally found a neurological and pain management specialist that got my migraines under control.
2004 I was diagnosed with peripheral neuropathy in my ankles and feet it’s all that up past my knees now. Taking a shower my knees down turn dark blue and are almost numb. I don’t trust my legs. I don’t trust them for driving long distances either.
Sitting and driving can then getting out too quickly can bring an episode. Getting out of a vehicle with A/C into an 75 degree day can bring on an episode. Bringing in more than myself from a grocery tore trip is a sure recipe for an episode and I HATE IT!!!
Have tremors all the time now. It started out just once in while about 2 years ago but it’s all the time.
Sooooooo
What do you all think? Do I have this dreased three letter monster or do you think it’s something else?
Ummm that’s why you need to have serious symptoms other than the 30bpm rise to be diagnosed. Symptoms of dysautonomia. Many pots people were athletes before getting pots.
That’s why other than the 30bpm increase, you need to have other POTS/disautonomia symptoms.
I started getting these tremors and falling, My hands and legs start wobbling and I can’t move, then I fall. It happens when I raise my
arms up will set the tremors off. I went to see a neurologist and he had me do the tilt table in which I had a reaction.
The neurologist calls my spells when I fall a seizure. I have my complete wits about me, so I don’t know. He said something about my blood from my heart not getting to my brain, or something like that. I have been dealing with this crap since 2014 and here it is 2019.
The neurologist said their is nothing you can do for it except eat more salt and drink plenty of water.
This happens to me all day long! It’s weird because once I fall, I usually don’t have the tremors the rest of the day, but of course I try to stay close to furniture in case I have to sit down quickly. It’s very hard once the tremors start, to move.
I’m a little over weight but that is not what causes this.
I was diagnosed with POTS about 8 years ago. This was after my husband found me passed out in our bathroom in the middle of the night. I went to the ER where I failed the “lie down, sit up, stand up” blood pressure tests, which cannot be “faked”. This was after multiple tests, an event monitor for 30 days, etc. After about 4 years of diet control, exercise and medication, things seemed to be better. I went off medication. My cardiologist retired and I did not replace him. I actually thought that this was a fluke, a make-believe disorder that I had “worked through”. It was like repetitive panic attacks without the panic. About 3 months ago, the symptoms came back with a vengeance. So much so, that I didn’t even consider POTS. Again, “panic attacks” without panic. After 3 weeks of having constant issues, I went to the ER. I thought I was ignoring heart attack symptoms. No heart attack, but a new cardiologist. I again “failed” the stress test, passed other key tests, and I am on a monitor for another 30 days. I have started the diet, but not loyally, and am attempting to be active. This may not seem like a big deal except that three months ago, I barely sat down. I am more active than most people half my age. Now…it is a struggle to take a shower or walk the dogs. I have not missed any work except for appointments, and am taking care of daily chores as well as I can, but every single thing I do is a struggle. My sleep issues or insomnia are out of control, just adding to the exhaustion I feel every day. I am completely spent. I am well on the way to completing the necessary monitoring to be diagnosed by a separate cardiologist with POTS. The return of symptoms has completely and utterly changed my life for the worse. Three months ago, I was shoveling the snow from the deck daily without incident, after working all day teaching. The snow we got two months ago of only 2 inches took three separate trips outside to clear the deck. I finally accept this is not a psychological disease, something I greatly feared. It is not make believe, and it is not easy to control. It has taken over my life. I will work to take it back, but as many POTS patients know, this is easier said than done. Three months ago, I could run circles around most people. For whatever reason, my remission ended promptly, my disorder came back with more intensity than I recall, and things I found as “routine” are nearly impossible. I am one of the lucky ones. I am still working everyday, and functional. But every single moment of that day is a struggle now that this has returned. If you are close to someone with POTS, please work hard to be understanding. Most likely, they do not understand this disorder themselves, and will need your support, and you encouragement to do whatever it takes to get his or her life back.
I have just be diagnosed by GP by reading my blood pressure and I’m to have compressed stockings. My diagnosis said I got it through having Sjorgrens Syndrome & also diagnosed with diabetes.Do I need further confirmation from a cardiologist.
I don’t know if you’ve seen a cardiologist yet but I was diagnosed with pots by my gp but refused medication until it could be confirmed by my cardiologist.. which I already have one due to another unrelated heart condition.
What meds do you tak
I have a question. I recently took a tilt-table test, and the cardiologist’s report–a visiting cardiologist, not my cardiologist–determined that the results were not indicative of POTS. Does the tilt-table test definitively rule out POTS, or would other tests be required? Thank you so much.
Did you found out the answer to your question? My daughter got the results today from her tilt table test and we were astound to hear the test was quite normal. The opposite of what she is experiencing at home.
Suggest you do the NASA 10 Minute Lean Test, you can do it easily at home if you can measure BP and HR.
Great and an informative article!
Best regards,
Demir Griffin
I am 81 and in August 2020 I had a bad fall. Since then I have great shortness of breath as soon as I stand. I just checked my oxygen with an oximeter and when sitting oxygen is usually 95 and heart rate is about 83. When standing and walking (not vigorous) oxygen stays the same but heart rate goes to 130+. I asked cardiologist who said “no” to Pots because of my age but did not test for it. Any toughts?
I’m trying to get diagnosed with this but the doctors are dragging ass. It is making work almost insufferable. They told me they have to do a bunch of other tests before they do the tilt table test.
Hi my name is Robbie & I have lived with postural orthostatic tachycardia syndrome aka POTS for 26 years. As I have gotten older the disease has increased to the point of brian damage, a 3-way break in my jaw due to passing out. I no longer can tolerate temperatures above 80° If I eat something large or small for, breakfast,lunch or dinner I lose energy & find that staying awake is impossible. Im able to eat one meal a day late in the afternoon now. I wake up to my blood pressure at 170 or so with a heart rate of 200 and as I slowly stand my blood pressure hits around 190 along with my heart rate around 300+ some time’s 400 or more beats per minute. If I get warm I sweat like crazy then quickly break out in itchy stinging & very painful like hives all over my back,chest an feet. 3 Time’s out of each 7day week/weekend I end up mentally & physically drained feeling low energy, sick like. I have had 4 sleep studies done that have shown that I could sleep for 7hrs without being fully asleep so I get 1 to 2hrs of sleep each night, Some weekends I’ll sleep 12hrs of the day away and still feel exhausted. I forget conversations quickly & space out many hours at a time. I have extremely high anxiety, depression, panic attacks & tend to blackout. I already have come to terms with the fact that this illness is going to continue to steal years of my life away & that I’ll be lucky to live past age 50 maybe hopefully longer. I truly have had a long life of struggles. Started doing hard physical demanding work at 6years old I would mow 15 yeards a week an at 8 I worked for my friends dad mixing concrete for yard curbside for a few years then at 10 I help tend a farm. All that money was used for groceries & to help my diabetic mother with the cost of her meds and continued hard work like fencing, asbestos removal, a welder & a freight truck unloader. I had a hard time keeping jobs because I ended up calling in sick way to much. I lived with my mom and continued to use what money I made to keep us afloat up until I hit age 23. That’s when my POTS condition went from terrible to unbearable. Few years later my girlfriend had our first baby girl & our second youngest when I was age 27. By then I had gained weight fell into a dark place do to pots. At age 30 I decided had enough of pots slowly killing me off, so I started to work out hard core lots of running, training & heavy wight lifting even when I would wake up from blacking out in the middle of working out alot! I was determined to try and beat the darn disease. After 6 months stright of working out 3 times every other day got me built like a grizzly for awhile. Anyways I’m a stay at home dad now & I’m 34 years old, I stand at 6’1 my weight is 245 im around 78% muscle mass. I truly try my hardest to push myself for my kids and for my wonderful loving & very caring Wife by doing whatever I possibly can with them on my good day’s. Trust I definitely pay for it the next day but building happy fun loving memories with my family is all I truly want. Its definitely hard because they know that my time here with them with my heart still beating is unpredictable. Pots disease is truly horrific. From a very young ager of teachers, Doctors & friends along with family members telling me that I was fine and needed to stop pretending feeling sick & acting tired,demanding I stop being so lazy in life. It definitely has left some deep scars over all them years of feeling alone wondering if they were right.. Anyways I truly pray & hope that one day a cure for pots will be created to destroy this terrible burden from children, adults and the elderly. God bless you all & thanks for taking a few to read. living with POTS Disease.
As a young toddler of under two years of age I would be playing and running around and would faint. Our family doctor sent me to both Waikato hospital in Hamilton and a Specialized Pediatricians. What was found was I was allergic to cow’s milk; my body was not producing enough rennin to break down caseinate (the protein)in cow’s milk. It is rennin that controls your blood pressure and also aldersterone. So for this treatment I would have to eat junket ever day made from goats milk and rennet to build my rennin levels up in my body. The tests also found I had Reyes Syndrome which is allergic to acetylsalicylic acid (salicylates) which causes both urticaria (hives), hay feverplus allergy migraines and a rare bleeding disorder so no aspirin allowed and a diet of low salicylates foods.
What is reason of high heart rate upto 110 for 10 seconds after standing from laying…
Robbie, this is like reading my own autobiography. I’m 63yo and been desperately trying for 10 years to get a firm diagnosis.
I have autoimmune illnesses as well, so a lot of my symptoms are put down to those and the ME/CFS I have. But I know in myself that there’s the real possibility of my having POTS too. Meanwhile I’m about to embark on yet another journey with yet a different Rheumatologist. My most recent Reactive Protein level is 13.8 (<3 is about normal) and this is while I'm taking 37.5mg prednisolone for a severe rheumatoid Arthritis /Lupus flare up. I feel I merely exist because I certainly don't call it living. It's a huge struggle when every bit of you hurts and you're burnt out exhausted all the time. The mental implications are enormous.
My 16 yr old daughter I think has pots but her pediatric said they cannot diagnose it they only check for problems within the heart and has referred us to another clinic, where we cant get into for another month. Her heart rate jumps up to 150 when she stands up.
How do I find a Dr that will legit check me for pots?
Five years to diagnosis (yesterday). For the record, I’m not overweight, and I wasn’t unfit until POTS. Although Ive been prescribed physical therapy, each time they have dropped me for passing out with moderate exercise. Lowest recorded blood pressure during an episode was unmeasurable (several times), more typical would be 70-90 over 40-60. Gentle indoor walking and my blood pressure goes dangerously high.