How to test for POTS: the tilt table test, the 10-minute stand test, and what to expect

Short answer

To test for POTS, a clinician measures your heart rate and blood pressure lying down, then while you stand or lie on a tilt table for 10 minutes. POTS fits when heart rate rises at least 30 bpm (40 bpm at ages 12–19) without a large blood-pressure drop, upright symptoms have lasted 3 months or more, and no other condition explains the fast heart rate. (pmc.ncbi.nlm.nih.gov)

POTS "is defined by chronic orthostatic intolerance accompanied by an excessive increment in sinus heart rate on standing in the absence of significant orthostatic hypotension" (Chopra, Frontiers in Neurology, 2026) — so the diagnosis is about a reproducible upright response, not one dramatic watch reading. (pmc.ncbi.nlm.nih.gov)

Two common ways to measure that response are a head-up tilt table test and an active stand / 10-minute stand test. Johns Hopkins states that POTS is diagnosed using either a 10-minute standing test or a head-up tilt table test, with other tests sometimes added to understand the person's POTS features or rule out other causes. (hopkinsmedicine.org) A 2019 NIH expert meeting reached the same conclusion: POTS can usually be identified with a 10-minute standing test, and tilt testing is most useful when fainting or nerve problems are suspected, or when a person cannot stand for 10 minutes. (pmc.ncbi.nlm.nih.gov)

Before calling it POTS, a clinician looks for other reasons your heart may race when you stand — for example dehydration or blood loss, anemia, thyroid disease, medication effects, arrhythmias, structural heart disease, and other systemic or neurologic causes. The Heart Rhythm Society consensus recommends history, physical exam, orthostatic vital signs, and a 12-lead ECG for people being assessed for POTS; selected patients may also need blood counts, thyroid testing, Holter monitoring, echocardiography, autonomic testing, tilt testing, or exercise testing. (pmc.ncbi.nlm.nih.gov)

What are the POTS diagnosis criteria?

A clinician is not just asking, "Does your heart rate get high?" They are asking, "Does your heart rate rise too much when you become upright, stay elevated long enough to count, match your symptoms, and happen without another explanation?" (pmc.ncbi.nlm.nih.gov)

In the 2015 Heart Rhythm Society consensus definition, POTS is usually characterized by frequent standing symptoms, a heart-rate increase of ≥30 beats per minute from lying to standing — or ≥40 beats per minute in people 12 to 19 years old — and absence of orthostatic hypotension. Johns Hopkins describes the heart-rate rise as measured during the first 10 minutes of standing or head-up tilt, and defines orthostatic hypotension as a 20 mm Hg systolic or 10 mm Hg diastolic drop in the first 3 minutes upright. (pmc.ncbi.nlm.nih.gov)

Newer consensus documents add two details that matter in real life. The 2019 NIH expert consensus and a 2022 review by Canadian and European POTS experts both require symptoms for at least 3 months, so a few bad weeks after an illness do not yet count. (pmc.ncbi.nlm.nih.gov) The 2022 review also says the heart-rate rise should show up on at least 2 readings taken at least 1 minute apart, not just once. (pmc.ncbi.nlm.nih.gov) If you want to know which symptoms usually come with this pattern, see our guide to POTS symptoms.

Why does "sustained" matter?

A quick jump in heart rate right after standing can happen in many people. POTS criteria refer to a sustained orthostatic tachycardia pattern — not a single second, not one stressful reading, and not a number taken after caffeine, exercise, fever, dehydration, pain, or panic. Reviews of POTS diagnosis emphasize that orthostatic tachycardia alone is not enough; the heart-rate pattern has to fit the symptoms and the rest of the evaluation. (pmc.ncbi.nlm.nih.gov)

Autonomic specialists make the same point about tilt testing: brief spikes above 30 bpm do not qualify for POTS when the average heart rate stays in the normal range. A rise that appears at the start of the test and then settles is more typical of normal standing physiology, test anxiety, or the motion of the table. (pmc.ncbi.nlm.nih.gov)

Why is blood pressure measured too?

POTS is "tachycardia" in the name, but the blood-pressure part is just as important. A person can feel dizzy and have a racing heart because their blood pressure drops when they stand; that is a different hemodynamic pattern from POTS. Johns Hopkins describes POTS as diagnosed only when orthostatic hypotension is ruled out and there is no acute dehydration or blood loss. (hopkinsmedicine.org)

One nuance: a brief dip in blood pressure in the first seconds after standing (called initial orthostatic hypotension) does not rule out POTS. What rules it out is a sustained drop that meets orthostatic hypotension criteria. (pmc.ncbi.nlm.nih.gov)

Why a resting heart rate floor exists

The Canadian Cardiovascular Society position statement set a minimum lying-down heart rate of 60 bpm for the diagnosis. The goal is to avoid labeling someone with POTS when a low resting heart rate simply climbs to a normal level on standing. (pmc.ncbi.nlm.nih.gov) The same statement warned that some people are given a POTS diagnosis without meeting criteria — for example, people with postural symptoms but no tachycardia, or a fast standing heart rate with no symptoms, or tachycardia with another clear cause. (doi.org)

How do you test for POTS? Tilt table test vs 10-minute stand test

Both tests ask the same physiologic question: what happens to your heart rate, blood pressure, and symptoms when your body becomes upright? The difference is how controlled the upright posture is.

Autonomic specialists recommend tilting to an angle between 60° and 80°, with 70° often preferred, because it puts nearly full gravitational stress on the circulation while limiting leg-muscle pumping. (pmc.ncbi.nlm.nih.gov) Johns Hopkins describes the tilt angle as roughly 60–80 degrees vertical for syncope evaluation. (hopkinsmedicine.org)

PoTS UK describes the active stand test as measuring heart rate and blood pressure after lying down, then immediately on standing and at frequent intervals until 10 minutes; NCBI Bookshelf gives a similar active stand structure with a supine baseline followed by standing readings at timed intervals. (potsuk.org)

Does the tilt table catch more POTS than standing?

Usually, yes — and that cuts both ways. In a 2025 study of 60 people with POTS who did both tests on the same day, 74% met the heart-rate criterion during a 10-minute active stand, compared with 98% during head-up tilt. (doi.org) An earlier study of 15 POTS patients and 15 healthy controls found tilt produced larger heart-rate rises than standing, but it also flagged more healthy people: at 10 minutes, the 30 bpm rule correctly cleared 40% of controls on tilt versus 67% on standing. (pmc.ncbi.nlm.nih.gov)

In plain terms, a tilt table is more likely to catch POTS, but a big heart-rate rise on tilt means less on its own. That is why Plash and colleagues concluded, in line with the consensus statements, that POTS should not be diagnosed from the heart-rate number alone, whichever test is used. (pmc.ncbi.nlm.nih.gov)

What happens during a tilt table test?

A tilt table test is designed to reproduce the body-position change that triggers symptoms, but in a safer and more observable way than "just standing up and hoping it happens." You are usually secured to the table, connected to blood-pressure and ECG monitoring, and watched by trained staff. European autonomic experts recommend safety straps across the chest and above the knee, and a table that can return you flat in under 15 seconds if you faint. (pmc.ncbi.nlm.nih.gov)

Typical steps may include:

1. Pre-test instructions. Your testing center may give instructions about food, fluids, caffeine, alcohol, and medications. A common approach is a light meal only, no alcohol or caffeine, and fasting or clear liquids for at least 2 hours before testing — but your own clinician's instructions should override general guidance. (pmc.ncbi.nlm.nih.gov)

2. Setup. Staff place ECG stickers on your chest, a blood-pressure cuff on your arm, and often a small finger cuff that tracks blood pressure with every heartbeat. (pmc.ncbi.nlm.nih.gov)

3. Resting baseline. You lie flat so the team can collect baseline heart rate, rhythm, and blood-pressure data. Consensus protocols call for at least 5 minutes of stable supine readings, and many labs use 10 minutes. (pmc.ncbi.nlm.nih.gov)

4. Tilt upright. The table moves toward an almost-standing position, usually between 60 and 80 degrees, often around 70 degrees. (pmc.ncbi.nlm.nih.gov)

5. Monitoring while upright. Staff track your symptoms and vital signs. For POTS, the key window is the first 10 minutes; Johns Hopkins describes an upright period up to 20–45 minutes in syncope tilt testing. (hopkinsmedicine.org)

6. Recovery. The table is returned flat, and your heart rate, rhythm, and blood pressure are monitored as you recover.

What does a tilt table test feel like?

For most of the test, it feels like lying on a narrow padded bed and then being slowly stood up by the bed. Your feet rest on a footplate, and straps hold you in place. The straps should feel secure, not tight. (pmc.ncbi.nlm.nih.gov)

The test itself is not painful. The arm cuff squeezes every few minutes, and a finger cuff may feel like a constant gentle pulse. Some people feel a brief spinning sensation as the table moves, which is one reason experts suggest raising the table slowly. (pmc.ncbi.nlm.nih.gov)

Once you are upright, your usual symptoms may appear — and that is the point. People commonly report dizziness, weakness, warmth, shortness of breath, nausea, or headache while tilted. (pmc.ncbi.nlm.nih.gov) If a fainting reflex starts, warning signs can include lightheadedness, feeling hot or cold, nausea, trouble focusing, muffled hearing, graying vision, palpitations, clammy skin, or an ache across the neck and shoulders. When those signs appear, staff stay right beside you and tilt you back down. (pmc.ncbi.nlm.nih.gov)

Tell the team what you feel as it happens. A tilt result is most meaningful when the symptoms it provokes are the ones you recognize from daily life. (pmc.ncbi.nlm.nih.gov)

Some syncope protocols add a medication partway through the tilt to make a fainting reflex more likely. European consensus does not recommend this step when orthostatic intolerance — including POTS or orthostatic hypotension — is the question. (pmc.ncbi.nlm.nih.gov) Autonomic specialists also note that drugs that raise heart rate, such as isoproterenol, can distort the heart-rate response during tilt. (pmc.ncbi.nlm.nih.gov) Ask in advance whether your protocol includes this step.

If you faint or come close during the test, expect to feel tired afterward — the Heart Rhythm Society notes that a vasovagal faint is typically followed by fatigue. Plan a quiet rest of the day if you can. (pmc.ncbi.nlm.nih.gov)

How long does a tilt table test take?

For a POTS-focused tilt, the monitored part is short: at least 5–10 minutes lying flat, then 10 minutes upright. (pmc.ncbi.nlm.nih.gov) European autonomic consensus lists a 10-minute tilt for POTS, 3 minutes for classic orthostatic hypotension, up to 40 minutes for delayed orthostatic hypotension, and up to 45 minutes when vasovagal fainting is being investigated. If a provocation medication is used, the tilt may be shortened to about 40 minutes: 20 minutes before and 20 minutes after it. (pmc.ncbi.nlm.nih.gov)

So the monitored portion alone can run from roughly 15–20 minutes for a POTS protocol to close to an hour for a full syncope protocol. Add time for check-in, setup, and recovery. The test can also end early if you faint, if your symptoms are clearly reproduced, or if you can no longer stay upright. (pmc.ncbi.nlm.nih.gov)

If you are not sure which protocol you are booked for, ask the lab. Many people are referred for fainting and POTS at the same time, and experts recommend tilt for exactly that combination because it can provoke both patterns. (pmc.ncbi.nlm.nih.gov) We explain how the two overlap in POTS, dysautonomia, and vasovagal syncope.

How do you prepare for a tilt table test?

Preparation instructions vary by center, so treat your lab's letter as the final word. These are the questions worth asking ahead of time:

• "Should I take my usual medications?" — Some medicines affect heart rate, blood pressure, or autonomic responses. Whether to continue or pause a drug depends on the clinical question, and experts stress that the full drug list must be reported so results can be interpreted. (pmc.ncbi.nlm.nih.gov) When POTS is being considered, stimulants, norepinephrine reuptake inhibitors, and anticholinergic drugs that raise heart rate are usually held — but only your prescriber should decide this. (pmc.ncbi.nlm.nih.gov)

• "Should I avoid caffeine, alcohol, nicotine, or heavy meals?" — These can affect heart rate, hydration, and symptoms. Consensus guidance suggests avoiding easily preventable vasoactive substances, such as caffeinated drinks and smoking, and eating no more than a light meal. (pmc.ncbi.nlm.nih.gov)

• "Should I empty my bladder first?" — Yes. Experts advise it, both to avoid extra stress on the nervous system and in case the test provokes fainting. (pmc.ncbi.nlm.nih.gov)

• "Does the time of day matter?" — It can. Upright heart rate tends to rise more in the morning (pmc.ncbi.nlm.nih.gov), and tilt is more likely to provoke fainting in the morning hours. (pmc.ncbi.nlm.nih.gov)

• "Can I drive afterward?" — Ask your center. Many recommend arranging a ride, especially if you might faint or feel drained after the test.

• "What symptoms should I report during the test?" — Reporting dizziness, nausea, chest sensations, tremor, sweating, visual changes, or near-fainting helps match symptoms with heart-rate and blood-pressure data. PoTS UK notes that symptoms are matched with HR and BP during testing. (potsuk.org)

• "What would make you stop the test?" — The test may stop if symptoms occur, blood pressure becomes too low, enough data have been collected, or the maximum testing time is reached. (potsuk.org)

What happens during the 10-minute stand test?

The active stand test is simpler than tilt testing, but it still needs careful measurement. In one commonly described protocol, the person lies supine for 10 minutes while baseline heart rate and blood pressure are measured, then stands while readings are repeated at intervals such as 1, 3, 5, and 10 minutes. (ncbi.nlm.nih.gov)

The 2022 CMAJ review describes a very similar version: lie flat for 5–10 minutes, then take readings after standing for 1, 3, 5, 8, and 10 minutes. A positive result needs a heart-rate rise of at least 30 bpm (40 bpm at ages 12–19) on at least 2 of the standing readings, with systolic blood pressure not falling by more than 20 mm Hg. (pmc.ncbi.nlm.nih.gov)

PoTS UK describes the active stand or NASA lean test as a way to diagnose PoTS under careful supervision, with heart rate and blood pressure measured after lying down, immediately after standing, and at frequent intervals until 10 minutes. (potsuk.org)

What does a positive POTS test look like?

A positive test is a pattern, not a single number. Current consensus criteria, as summarized in the 2022 CMAJ review, include these pieces: (pmc.ncbi.nlm.nih.gov)

• a sustained heart-rate rise of ≥30 bpm (≥40 bpm at ages 12–19) within 10 minutes of standing or tilt;

• the rise seen on more than one reading, not a brief spike;

• no sustained blood-pressure drop of 20/10 mm Hg or more;

• upright symptoms that ease when you lie down, present for 3 months or longer;

• no other condition that explains the fast heart rate.

European tilt-testing consensus also lists an upright heart rate above 120 bpm as a qualifying heart-rate finding, while stressing that POTS remains a clinical diagnosis that requires symptoms of orthostatic intolerance. (pmc.ncbi.nlm.nih.gov) The Heart Rhythm Society notes that standing heart rate in POTS is often ≥120 bpm. (pmc.ncbi.nlm.nih.gov)

What if the test is positive but something else is going on?

A fast standing heart rate with no symptoms is a non-specific finding, and dehydration should be considered first. If you faint during a tilt, the early fast heart rate may be part of the fainting reflex rather than POTS, and experts suggest repeating the tilt to see whether POTS shows up again. (pmc.ncbi.nlm.nih.gov) Autonomic specialists also note that POTS and fainting sometimes occur in the same person. (pmc.ncbi.nlm.nih.gov)

What if the test is negative but symptoms are real?

Orthostatic heart rate naturally varies from day to day and is usually higher in the morning. If a clinician strongly suspects POTS but the first test is borderline, the 2022 CMAJ review recommends reassessing on another day, preferably in the morning. (pmc.ncbi.nlm.nih.gov) The Heart Rhythm Society likewise says a tilt test may help when orthostatic vital signs are normal but suspicion is high, because it records vital signs over a longer period than a simple stand test. (pmc.ncbi.nlm.nih.gov)

What is the "poor man's tilt table test"?

"Poor man's tilt table test" is an online nickname for measuring your own heart rate lying down and then standing, usually for 10 minutes. The two versions people mean are the active stand test (standing freely) and the NASA lean test (standing with your upper back against a wall).

In the NASA lean test, heart rate and blood pressure are taken after resting lying down, then every minute for 10 minutes while you stand with only your shoulder blades touching a wall for a relaxed stance. (pmc.ncbi.nlm.nih.gov) Instructions typically place the heels about 6 inches (15 cm) from the wall and ask you not to move, tense, or shift your weight. (pmc.ncbi.nlm.nih.gov)

The lean test spread quickly during the COVID-19 pandemic, including among people with long COVID symptoms, because it needs no special equipment. But European autonomic experts caution that it has not been validated against tilt or standard active stand testing, that leaning may change how much your leg muscles help pump blood back to the heart, and that self-administered tests have produced many inaccurate self-diagnoses. They recommend the standard active stand test instead and say results should be interpreted by clinicians, not by patients themselves. (pmc.ncbi.nlm.nih.gov)

So the honest answer is this: a home stand test can give your clinician useful data, but it cannot confirm or rule out POTS on its own.

How to do a home stand test safely (if your clinician asks for one)

If your doctor asks you to collect readings at home, a structure based on the clinical active stand test looks like this (pmc.ncbi.nlm.nih.gov):

1. Have someone with you the whole time, and stand next to a bed or sturdy chair you can sit or lie on immediately.

2. Test in the morning if possible, before caffeine, and note what you ate and drank.

3. Lie flat for 5–10 minutes, then record heart rate and blood pressure.

4. Stand up and stay still — no talking, walking, fidgeting, or leaning on your hands.

5. Record heart rate and blood pressure at 1, 3, 5, 8, and 10 minutes, plus any symptoms at each point.

6. Stop and lie down right away if you feel faint, have chest pain, feel very short of breath, or your helper sees you turn pale or unsteady.

Do not do a home stand test at all if you have fainted without warning, injured yourself when fainting, have chest pain with standing, or have been told not to.

What would count as a "positive" home reading?

Against the clinical criteria, the pattern to look for is a heart-rate rise of ≥30 bpm (≥40 bpm at ages 12–19) on at least 2 standing readings, without a blood-pressure drop of 20/10 mm Hg or more, in someone with upright symptoms for 3 months or longer. (pmc.ncbi.nlm.nih.gov) Even then, it is a reason to book an appointment — not a diagnosis. Home cuffs and wrist devices can be inaccurate, and other causes still need to be ruled out.

How to make stand-test data more useful for your clinician

This is not a diagnosis checklist, but if your clinician asks you to record data before a visit, the most useful notes are usually the boring ones: time, posture, heart rate, blood pressure, symptoms, and what was happening around the measurement. PoTS UK notes that some patients are asked to keep a diary of heart rate and blood pressure while lying, sitting, or standing, and that it can help to record posture and symptoms at the same time. (potsuk.org) Our blood pressure log for your doctor shows a simple format.

• Date and time — Morning readings may differ from later readings; reviews note diurnal variability in orthostatic tachycardia. (pmc.ncbi.nlm.nih.gov)

• Posture — Lying, sitting, standing, or leaning

• Heart rate — Baseline and upright values, with timestamps

• Blood pressure — Especially important because a BP drop changes the interpretation

• Symptoms — Lightheadedness, palpitations, tremor, nausea, brain fog, chest discomfort, shortness of breath, near-fainting

• Context — Sleep, hydration, illness, menstrual cycle, medications, caffeine, meal timing, heat exposure, exercise, stress

• Safety note — Do not do an unsupervised stand test if you are likely to faint, have chest pain, feel severely short of breath, or have been told not to stand for testing

Can you test for POTS at home with a wearable?

A wearable, pulse oximeter, blood-pressure cuff, or app can help you track what happens to your heart rate when you move from lying to standing. That can be useful because symptoms may vary by day, time, hydration, sleep, meals, heat, and medication timing. But a wearable or "POTS test online" cannot diagnose POTS by itself. PoTS UK says recordings can help prepare for a medical appointment, but also warns that monitors can be inaccurate, uncalibrated, or anxiety-provoking if used too often. (potsuk.org)

A smartwatch heart-rate spike is also not enough because POTS diagnosis requires a pattern: upright symptoms, a sustained orthostatic heart-rate rise, blood-pressure interpretation, and exclusion of other causes. Johns Hopkins notes POTS is diagnosed only when orthostatic hypotension is ruled out and there is no acute dehydration or blood loss. (hopkinsmedicine.org) Most watches also do not measure blood pressure, which is half of the test. A single resting value tells you even less — see what a normal resting heart rate is and why it varies so much between people.

What our own data shows: a resting number can't catch POTS.

We looked at 359 Welltory users who self-reported POTS and had about three months of quality wearable data, compared with 3,786 users without it. Their resting heart rate was only about 3 bpm higher on average (66 vs 62 bpm) — a small difference, and when we compared people with a similar number of other conditions, even that gap mostly disappeared. The two groups overlap almost entirely: about 77% of the POTS group had a resting heart rate inside the normal range of everyone else (roughly 53–73 bpm), and resting heart rate on its own separated the groups barely better than a coin flip. In plain terms, the number a watch shows you while you sit still cannot identify POTS — which is exactly why the diagnostic criterion is about how much your heart rate rises when you stand, not a single resting value.

Welltory user data, self-reported POTS, observational. All figures are reported as anonymized, aggregated data; no individual user is identifiable. This is not a diagnostic tool.

Where Welltory fits: the Welltory Science Lab Orthostatic Test and a compatible wearable can help you track standing-heart-rate patterns over time and bring clearer observations to a clinician. It does not diagnose POTS, confirm dysautonomia, or replace a clinical stand test, tilt table test, ECG, bloodwork, or specialist evaluation. You can see how your own readings shift across days in My Patterns.

A good at-home log is short, not huge

If your clinician asks for home data, bring a concise summary rather than hundreds of screenshots. PoTS UK suggests that clinicians may not have time to read many pages of recordings and that it can be useful to keep recordings from an especially good and bad day for the next appointment. (potsuk.org)

What doctor diagnoses POTS?

POTS may be diagnosed by a cardiologist, neurologist, autonomic specialist, electrophysiologist, pediatrician, or another clinician familiar with orthostatic disorders. PoTS UK says people are often diagnosed by a cardiologist, neurologist, medicine-for-the-elderly consultant, or pediatrician, and that a GP can also diagnose PoTS when the criteria are met. (potsuk.org)

In a survey of 4,835 people with a physician-made POTS diagnosis, the diagnosis most often came from a general cardiologist (41%), followed by a neurologist (19%), a cardiac electrophysiologist (15%), and a family physician (8%). (pmc.ncbi.nlm.nih.gov)

In real life, the workup often starts with a primary care clinician because the symptoms overlap with many common problems: anemia, thyroid disease, dehydration, medication effects, anxiety-like palpitations, arrhythmias, long-lasting fatigue syndromes, and fainting disorders. The Heart Rhythm Society consensus recommends a complete history and physical exam, orthostatic vital signs, and a 12-lead ECG for people being assessed for POTS. (pmc.ncbi.nlm.nih.gov) The 2022 CMAJ review adds that primary care physicians and pediatricians can perform the initial evaluation and start POTS treatment, with referral to a POTS expert if the response is poor. (pmc.ncbi.nlm.nih.gov)

How long does it take to get a POTS diagnosis?

There is no single timeline. Some people are diagnosed after a clear orthostatic vital-sign exam or stand test; others need ECG, bloodwork, ambulatory monitoring, autonomic testing, or tilt table testing because symptoms overlap with other conditions. Johns Hopkins notes that diagnosis can be complicated because symptoms affect multiple organ systems and may be present for months before diagnosis. (hopkinsmedicine.org)

Survey data show how long that road can be. In the same survey of 4,835 people, the median delay from first seeing a doctor to diagnosis was 24 months, and people saw a median of 5 physicians first. Three in four (75%) said they had been misdiagnosed, and 77% had been told their symptoms were psychiatric or psychological — although only 28% reported actually having a psychiatric or psychological condition before diagnosis. (pmc.ncbi.nlm.nih.gov) These are self-reported figures from an online survey, but the authors also found the delay has been shrinking over time.

What can speed things up: describing symptoms by posture ("worse standing, better lying down"), bringing a short heart-rate and blood-pressure log, and asking directly for orthostatic vital signs at the visit.

What tests rule out conditions that look like POTS?

POTS is partly a rule-in diagnosis and partly a rule-out diagnosis. Your clinician is trying to answer: "Is this POTS, another orthostatic disorder, a heart rhythm problem, a blood-pressure problem, a systemic medical condition, or more than one thing at the same time?"

The NIH expert consensus lists, at a minimum, a complete blood count, electrolytes, thyroid function tests, and an ECG, with other tests guided by the clinical picture. (pmc.ncbi.nlm.nih.gov) The 2022 CMAJ review suggests core labs including hemoglobin, electrolytes, kidney function, ferritin, thyroid-stimulating hormone, and morning cortisol. (pmc.ncbi.nlm.nih.gov)

• History and physical exam — Pattern of symptoms, triggers, chronicity, fainting history, family history, medications, hydration, menstrual or illness triggers, comorbid conditions. The exam often includes a check for joint hypermobility, because POTS and hypermobile Ehlers-Danlos syndrome often occur together. (pmc.ncbi.nlm.nih.gov)

• Orthostatic vital signs — Heart-rate and blood-pressure response from lying to standing

• 12-lead ECG — Screens for rhythm or conduction findings that could mimic or complicate POTS, such as other heart arrhythmias and palpitations; recommended in the Heart Rhythm Society consensus evaluation. (pmc.ncbi.nlm.nih.gov)

• CBC / blood count — Can help identify anemia or other blood-related contributors; the Heart Rhythm Society consensus says complete blood count can be useful for selected patients. (pmc.ncbi.nlm.nih.gov)

• Thyroid testing — Helps rule out thyroid disease as a contributor to tachycardia; thyroid function studies can be useful for selected patients. (pmc.ncbi.nlm.nih.gov)

• Kidney function, glucose, ferritin, B12, folate, vitamin D, morning cortisol, celiac screen — Depending on symptoms and history, PoTS UK lists these among blood tests used to rule out other conditions. (potsuk.org)

• Holter or ambulatory heart monitor — Helps capture heart rhythm over time and distinguish sinus tachycardia from other arrhythmias; the Heart Rhythm Society consensus says a 24-hour Holter may be considered in selected patients. A Holter can also detect inappropriate sinus tachycardia, where heart rate is high regardless of posture. (pmc.ncbi.nlm.nih.gov)

• Echocardiogram — Looks at heart structure when history, exam, ECG, or symptoms suggest it is needed; the Heart Rhythm Society consensus lists transthoracic echocardiogram as a test that may be considered in selected patients. (pmc.ncbi.nlm.nih.gov)

• Plasma catecholamines — Sometimes measured lying and standing in an advanced workup; a large rise in norepinephrine on standing may point to a "hyperadrenergic" pattern, which some people experience as adrenaline-dump episodes. (pmc.ncbi.nlm.nih.gov)

• Autonomic testing — May include Valsalva maneuver, deep breathing tests, QSART, sudomotor testing, or specialist autonomic lab evaluation; Johns Hopkins lists Valsalva and QSART among other POTS tests used in some cases. (hopkinsmedicine.org)

• Tilt table test — Helps document heart-rate and blood-pressure responses in a controlled setting and can also support evaluation for syncope or orthostatic hypotension. (pmc.ncbi.nlm.nih.gov)

The 2022 CMAJ review notes that, aside from an ECG, routine cardiovascular or neurologic investigations are not recommended for everyone — extra tests should follow from what the first evaluation finds. (pmc.ncbi.nlm.nih.gov)

How is testing for dysautonomia different from a POTS test?

"Dysautonomia" is an umbrella term. It means the autonomic nervous system — the system that helps regulate heart rate, blood pressure, sweating, digestion, temperature control, and other automatic functions — is not working normally. Johns Hopkins describes POTS as a form of dysautonomia, but not all dysautonomia is POTS. (hopkinsmedicine.org) For a broader overview, see what dysautonomia is.

That distinction matters for testing. A POTS standing test mainly looks for the POTS hemodynamic pattern. Broader autonomic dysfunction testing may look at sweat responses, heart-rate variability with breathing, the Valsalva maneuver, blood-pressure control, and sometimes small-fiber nerve function. Johns Hopkins lists Valsalva and QSART as examples of additional tests that may be used in some POTS evaluations. (hopkinsmedicine.org) The NIH consensus notes that these tests are normal in most, but not all, people with POTS; abnormal sweat tests or skin biopsies may point to an underlying small-fiber neuropathy, sometimes called "neuropathic POTS." (pmc.ncbi.nlm.nih.gov) Findings like these feed into the bigger question of what causes POTS in a particular person.

What about genetic testing for familial dysautonomia?

Familial dysautonomia is a specific inherited disorder, not the same thing as POTS. MedlinePlus Genetics describes familial dysautonomia as a genetic disorder affecting development and survival of certain nerve cells, while GeneReviews says diagnosis is established by suggestive findings plus biallelic pathogenic or likely pathogenic variants in ELP1 identified by molecular genetic testing. Genetic testing for familial dysautonomia is therefore not a routine "POTS test"; it is considered when the clinical picture suggests that specific inherited condition. (medlineplus.gov)

What should you bring to a POTS evaluation?

Bring your clinician the kind of information that helps them see the pattern quickly:

• A symptom timeline: when symptoms started, what changed around that time, whether they are daily or episodic, and what makes them better or worse.

• Posture-linked symptoms: what happens lying down, sitting, standing, showering, after meals, in heat, after exertion, and after long periods upright.

• Medication and supplement list: including stimulants, decongestants, antidepressants, blood-pressure medications, beta-blockers, diuretics, and anything started or stopped recently.

• Hydration and food context: dehydration, acute blood loss, alcohol, caffeine, large meals, and salt intake can all change upright heart-rate and blood-pressure readings.

• Home data if requested: heart rate, blood pressure, posture, timestamps, and symptoms — preferably a concise log rather than many screenshots. PoTS UK says matching recordings with posture and symptoms can be helpful before a medical appointment. (potsuk.org)

• Fainting details: what you were doing, warning symptoms, injuries, exertion, whether you were lying down, and how quickly you recovered. The American Heart Association notes syncope has many causes, from benign triggers to serious cardiac conditions, and recommends initial evaluation with history, physical exam, and heart-rate and blood-pressure checks. (heart.org)

When should you seek urgent medical care?

Do not wait for a scheduled POTS test if you have symptoms that could be cardiac, pulmonary, neurologic, or otherwise urgent. Seek immediate medical help for chest pain or discomfort, severe or new shortness of breath, fainting or near-fainting that is new or concerning, severe weakness, new neurologic symptoms, or a rapid/irregular heartbeat with concerning symptoms. The American Heart Association says chest pain should not be ignored and that people with chest pain should call emergency services or their healthcare provider for guidance, and notes that some causes of fainting are serious heart conditions. (heart.org)

How Welltory fits

Welltory can help you observe what your body does across real life — not just during one appointment. The Welltory Science Lab Orthostatic Test can help you track lying-to-standing heart-rate patterns over time, notice symptom context, and prepare a cleaner conversation with your clinician.

What Welltory can do:

• help you record orthostatic patterns repeatedly;

• make it easier to notice "good day vs bad day" differences;

• support a symptom-and-posture log you can discuss with a clinician;

• encourage a more objective conversation about standing heart rate.

What Welltory cannot do:

• diagnose POTS;

• rule out arrhythmia, anemia, thyroid disease, dehydration, orthostatic hypotension, syncope disorders, or structural heart disease;

• replace blood-pressure measurement during testing;

• replace a clinician's interpretation of your symptoms, exam, ECG, labs, and orthostatic vital signs.

How we made it

Made with AI tools, then edited, fact-checked, and medically reviewed by the Welltory team.

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