POTS Evaluation and Testing
1.) Patient History
• Underlying Causes (please look at the What Causes POTS page for common POTS causes)
• Associated disorders (please look at the Co-occurring Conditions page for other conditions to be mindful of)
• Triggers and symptom patterns (please look at the Navigating Flare-ups page for common POTS triggers)
• Symptom severity (please look at the POTS Symptoms page for common symptoms experienced)
• Exercise tolerance
• Quality of life
2.) Physical Examination
3.) Orthostatic Vital Signs
• Should be taken regularly (after assuming a standing position), while also recording symptoms experienced; measure heart rate (HR) and blood pressure (BP) after individual has been lying supine for 5-10 minutes, then have individual stand and measure HR and BP when standing for 1, 3, 5, 8, and 10 minutes (Raj et al., 2022). Also known as the “Poor Man’s Tilt Table Test,” we made a link that contains instructions your providers can use below.
• See heart rate and blood pressure criteria above under “Diagnostic Criteria” to see if all criteria are met.
Poor Man's Tilt Table Test PDF
• A tilt table test can also be performed, as it can lead to greater increases in HR, and therefore increased diagnostic sensitivity (Thijs et al., 2021).
• It may also be helpful to perform testing in the morning as opposed to the afternoon or evening, given the increased sensitivity to orthostatic intolerance and symptoms in the morning (Brewster et al., 2011).
4.) 12-lead Electrocardiography (ECG)
5.) 24-hour Holter Monitor (or longer)
• This is useful for detecting any abnormalities and inappropriate sinus tachycardia
6.) Echocardiography (if cardiac exam is abnormal)
7.) Laboratory Testing
• This can be used to rule out other potential causes of orthostatic intolerance
• These tests can include, but are not limited to, CBC, CMP, Renal function, Ferritin, TSH, AM Cortisol, and/or Vitamin D
All of these components are often sufficient to establish a diagnosis of POTS and begin appropriate treatment. This being said, if you do not respond to treatments initially suggested or used, providers should consider referring you to a known POTS specialist (Raj et al., 2022).
Sources:
Brewster, J. A., Garland, E. M., Biaggioni, I., Black, B. K., Ling, J. F., Shibao, C. A., Robertson, D., & Raj, S. R. (2011). Diurnal variability in orthostatic tachycardia: Implications for the postural tachycardia syndrome. Clinical Science, 122(1), 25–31. https://doi.org/10.1042/cs20110077
Raj, S. R., Fedorowski, A., & Sheldon, R. S. (2022). Diagnosis and management of postural orthostatic tachycardia syndrome. Canadian Medical Association Journal, 194(10). https://doi.org/10.1503/cmaj.211373
Thijs, R. D., Brignole, M., Falup-Pecurariu, C., Fanciulli, A., Freeman, R., Guaraldi, P., Jordan, J., Habek, M., Hilz, M., Pavy-LeTraon, A., Stankovic, I., Struhal, W., Sutton, R., Wenning, G., & van Dijk, J. G. (2021). Recommendations for Tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness : Consensus statement of the European Federation of Autonomic Societies (EFAS) endorsed by the American Autonomic Society (AAS) and the European Academy of Neurology (EAN). Autonomic Neuroscience, 233, 102792. https://doi.org/10.1016/j.autneu.2021.102792
• A tilt table test can also be performed, as it can lead to greater increases in HR, and therefore increased diagnostic sensitivity (Thijs et al., 2021).
• It may also be helpful to perform testing in the morning as opposed to the afternoon or evening, given the increased sensitivity to orthostatic intolerance and symptoms in the morning (Brewster et al., 2011).
4.) 12-lead Electrocardiography (ECG)
5.) 24-hour Holter Monitor (or longer)
• This is useful for detecting any abnormalities and inappropriate sinus tachycardia
6.) Echocardiography (if cardiac exam is abnormal)
7.) Laboratory Testing
• This can be used to rule out other potential causes of orthostatic intolerance
• These tests can include, but are not limited to, CBC, CMP, Renal function, Ferritin, TSH, AM Cortisol, and/or Vitamin D
All of these components are often sufficient to establish a diagnosis of POTS and begin appropriate treatment. This being said, if you do not respond to treatments initially suggested or used, providers should consider referring you to a known POTS specialist (Raj et al., 2022).
Sources:
Brewster, J. A., Garland, E. M., Biaggioni, I., Black, B. K., Ling, J. F., Shibao, C. A., Robertson, D., & Raj, S. R. (2011). Diurnal variability in orthostatic tachycardia: Implications for the postural tachycardia syndrome. Clinical Science, 122(1), 25–31. https://doi.org/10.1042/cs20110077
Raj, S. R., Fedorowski, A., & Sheldon, R. S. (2022). Diagnosis and management of postural orthostatic tachycardia syndrome. Canadian Medical Association Journal, 194(10). https://doi.org/10.1503/cmaj.211373
Thijs, R. D., Brignole, M., Falup-Pecurariu, C., Fanciulli, A., Freeman, R., Guaraldi, P., Jordan, J., Habek, M., Hilz, M., Pavy-LeTraon, A., Stankovic, I., Struhal, W., Sutton, R., Wenning, G., & van Dijk, J. G. (2021). Recommendations for Tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness : Consensus statement of the European Federation of Autonomic Societies (EFAS) endorsed by the American Autonomic Society (AAS) and the European Academy of Neurology (EAN). Autonomic Neuroscience, 233, 102792. https://doi.org/10.1016/j.autneu.2021.102792
4.) 12-lead Electrocardiography (ECG)
5.) 24-hour Holter Monitor (or longer)
• This is useful for detecting any abnormalities and inappropriate sinus tachycardia
6.) Echocardiography (if cardiac exam is abnormal)
7.) Laboratory Testing
• This can be used to rule out other potential causes of orthostatic intolerance
• These tests can include, but are not limited to, CBC, CMP, Renal function, Ferritin, TSH, AM Cortisol, and/or Vitamin D
All of these components are often sufficient to establish a diagnosis of POTS and begin appropriate treatment. This being said, if you do not respond to treatments initially suggested or used, providers should consider referring you to a known POTS specialist (Raj et al., 2022).
Sources:
Brewster, J. A., Garland, E. M., Biaggioni, I., Black, B. K., Ling, J. F., Shibao, C. A., Robertson, D., & Raj, S. R. (2011). Diurnal variability in orthostatic tachycardia: Implications for the postural tachycardia syndrome. Clinical Science, 122(1), 25–31. https://doi.org/10.1042/cs20110077
Raj, S. R., Fedorowski, A., & Sheldon, R. S. (2022). Diagnosis and management of postural orthostatic tachycardia syndrome. Canadian Medical Association Journal, 194(10). https://doi.org/10.1503/cmaj.211373
Thijs, R. D., Brignole, M., Falup-Pecurariu, C., Fanciulli, A., Freeman, R., Guaraldi, P., Jordan, J., Habek, M., Hilz, M., Pavy-LeTraon, A., Stankovic, I., Struhal, W., Sutton, R., Wenning, G., & van Dijk, J. G. (2021). Recommendations for Tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness : Consensus statement of the European Federation of Autonomic Societies (EFAS) endorsed by the American Autonomic Society (AAS) and the European Academy of Neurology (EAN). Autonomic Neuroscience, 233, 102792. https://doi.org/10.1016/j.autneu.2021.102792
• These tests can include, but are not limited to, CBC, CMP, Renal function, Ferritin, TSH, AM Cortisol, and/or Vitamin D
All of these components are often sufficient to establish a diagnosis of POTS and begin appropriate treatment. This being said, if you do not respond to treatments initially suggested or used, providers should consider referring you to a known POTS specialist (Raj et al., 2022).