Diagnosing POTS

Your health care team can easily check for POTS using a 10-minute active stand test. To do this, they will measure your heart rate and blood pressure when you are lying down and again several times when you are standing up. Experts say a table tilt test is not always needed unless symptoms are unclear or fainting is a concern. 

A telltale sign of POTS is a sustained rise in heart rate (not just an immediate increase that gets better) when you move to an upright position, while blood pressure remains mostly unchanged. The higher rate lasts for 10 minutes with increases of:

• 30 beats per minute or more for adults
• 40 beats per minute or more for children and teens

Your care team will also ask about and consider your medical history and any symptoms. For example, they may ask whether your symptoms start or get worse when you sit or stand, and whether they improve when you lie down. POTS may be suspected if symptoms begin after a viral illness, surgery or a period of bed rest, especially in an otherwise healthy person.

Other tests may be added to help rule out other causes of your symptoms. For example, an electrocardiogram, heart monitor or blood tests. Several conditions can cause symptoms similar to POTS, coexist with POTS, or contribute to POTS-like symptoms. These include: 

• Heart rhythm problems
• Thyroid disease
• Anemia
• Dehydration
• Other autonomic conditions
• Anxiety or panic symptoms
• Long COVID

Having anxiety does not mean that POTS symptoms are “all in your head,” and Long COVID may sometimes be associated with POTS rather than simply mimic it. A careful evaluation can help identify what is contributing to your symptoms.

Some medications, for example stimulants and diuretics, also can affect heart rate. Be sure to review the medications you take at your health visits. 

POTS often occurs alongside other conditions. For example:

• Migraine
• Ehlers‑Danlos syndrome (EDS) – a genetic condition that weakens the body’s connective tissues
• Autoimmune conditions
• Gut or digestive issues
• Mast cell activation disorder – a condition where mast cells of the immune system are overactive and release chemicals like histamine that can trigger symptoms
• Chronic fatigue syndrome
• Fibromyalgia

This can make diagnosis more challenging and may also influence how POTS is best managed.