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
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How are you feeling now – I have it too
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.
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.
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.
Great and an informative article!
Best regards,
Demir Griffin