How the diagnosis is made

The assessment generally begins with a detailed conversation, a physical examination with heart rate and blood pressure measurements, lying down and then standing, and an electrocardiogram. This approach is usually enough to make the diagnosis2.

The standing test

During this test, sometimes called the Schellong test, the person first lies down for 5 to 10 minutes, then heart rate and blood pressure are measured several times over 10 minutes of standing, while the symptoms are noted3. If a first test is not conclusive despite a strong suspicion, it is considered prudent to repeat it, preferably in the morning, when the measurements are thought to be more sensitive4.

The tilt test

The tilt test, or tilt table test, is done lying on a table that is tilted upwards, while heart rhythm is monitored5. It is not essential, but it can help, for example if the standing test is normal despite a strong suspicion or if the person cannot stand for 10 minutes; it is mainly carried out in specialist centres5.

Ruling out other causes

Before settling on the diagnosis, healthcare professionals look in particular for dehydration or blood loss, anaemia, a thyroid or adrenal gland disorder, the effect of a medicine or a drug, fever, infection, pain, prolonged bed rest, or severe anxiety6.

A basic blood test generally looks at haemoglobin, electrolytes, the kidneys, iron stores (ferritin), the thyroid and sometimes cortisol; what happens next depends on the results7. More extensive tests of the heart or nervous system are not recommended routinely8.

The care options described

To date, no treatment makes POTS go away, and none is effective for everyone: the goals are to understand the syndrome, relieve symptoms and improve physical fitness and quality of life9. Care generally begins with information, described as a key element, and measures that do not involve medicines10. Finding what works can take time, and several approaches are often combined11.

The points below are topics to discuss, not instructions.

  • Reviewing your current medicines. Some can make the faster heart rate worse; stopping or replacing them is decided with your doctor, never on your own12.
  • Water and salt. Increasing these intakes is described as a way to increase blood volume, but the real benefit and the right amount remain to be established, and it is not suitable for everyone (high blood pressure, heart or kidney disease, for example)13. Do not increase your salt intake without first talking to a healthcare professional.
  • Compression garments. Reaching up to the waist, sometimes with compression of the abdomen, they limit the shift of blood towards the lower body and reduced the faster heart rate in one trial14.
  • Exercise reconditioning. A regular, progressive and supervised programme, starting with exercises that are not done standing (recumbent bike, rowing machine, swimming), is recommended by professional societies. You may feel worse at first, and improvement may not appear for a month15.
  • Spotting what makes symptoms worse. Limiting dehydration, sudden changes of position, prolonged standing, heat, large meals or alcohol is among the measures described16. The NHS also describes manoeuvres for moments when you feel you are about to faint, such as lying down with your legs raised17.
  • Medicines, in some cases. They may be considered if symptoms are severe or persist despite the other measures; they mainly aim to slow the heart, constrict blood vessels or increase blood volume18. The evidence for their effectiveness remains limited: no large rigorous trial has been conducted, and no medicine is authorised specifically for POTS in North America19.

Professional societies advise against heart procedures offered for POTS, owing to a lack of evidence of benefit and serious risks, and against regular infusions as a routine measure20. Be cautious about offers that promise a quick solution.

Who is involved

Your family doctor or paediatrician can carry out the initial assessment and coordinate follow-up21. A specialist is called in if the initial measures are not enough, if the symptoms are very disabling or if their cause is unclear22. Depending on your needs, a cardiologist, a neurologist, a physiotherapist, a psychologist or an occupational therapist may be involved21. Associated conditions, such as migraine, also deserve to be treated23.

For adolescents, doctors at Geneva University Hospitals (HUG) stress the importance of acknowledging the complaint, involving parents, supporting the young person in staying in school and, if needed, offering psychological support24.

Preparing for your appointment

Healthcare professionals are interested in particular in when the symptoms began, what triggers or relieves them, their impact, physical activity, medicines and supplements, and family history25. A few notes taken over the preceding days can help you:

  • when the symptoms started, and whether something happened just before (infection, operation, pregnancy…);
  • when they appear (standing, on waking, after a meal, in the heat, during your period…) and what relieves them;
  • what they stop you from doing: school, work, sport, going out;
  • your medicines, your contraception and your supplements;
  • known health problems in your family.

Note down how you feel, without trying to reproduce the test yourself: the measurements are taken at the appointment, following a precise protocol3.

Questions to ask

  • On what basis would you say that this is, or is not, POTS in my situation?26
  • Which other causes need to be ruled out, and with which tests?6
  • Would a tilt test be useful in my case?5
  • Could one of my medicines be playing a role?12
  • Are my water and salt intakes appropriate for my health?13
  • Would an exercise reconditioning programme or compression garments suit me? Who can support me with this?15
  • Is a medicine being considered? What can I expect from it, what side effects can it have, and what is known about its effectiveness?19
  • How can school or work be adapted during this period?27

My own questions

Space to write by hand (4 lines).

Sources for this page

Each number leads to a neutral statement and to the documents that support it. We summarise these sources in our own words; the links open the original documents.

  1. 1

    According to the Heart Rhythm Society consensus statement, care decisions are made jointly by clinicians and patients, taking each person's situation into account.

    Expert consensus · checked on 18 October 2026

    Back to the text
  2. 2

    The assessment of suspected POTS includes a detailed history, a physical examination with heart rate and blood pressure measured lying down and then standing (noting symptoms) and an electrocardiogram; this minimal approach is generally enough to make the diagnosis and begin management.

    Recommendation · checked on 18 October 2026

    HRS class I recommendation for the history, the examination with orthostatic vital signs and the electrocardiogram.

    Back to the text
  3. 3

    For the standing test, heart rate and blood pressure are measured after 5 to 10 minutes lying down, then several times (for example at 1, 3, 5, 8 and 10 minutes) after moving to a standing position, noting symptoms; a Revue Médicale Suisse article calls it the Schellong test.

    Expert consensus · checked on 18 October 2026

    The HAS describes measurements after 10 minutes of lying at rest, then at 1, 3, 5 and 10 minutes standing.

    Back to the text
  4. 4

    Morning assessments are probably more sensitive; if POTS is strongly suspected but the first examination does not meet the criterion, it is considered prudent to repeat the examination later, preferably in the morning.

    Expert consensus · checked on 18 October 2026

    • Diagnostic et traitement du syndrome de tachycardie orthostatique posturale (new tab) — Canadian Medical Association Journal (CMAJ), CMAJ 2022;194(24):E852–E858, 20 June 2022; translation of CMAJ 2022;194(10):E378–E385 (text read in PMC9261951, where the sections on treatment are missing) (in French). Passage: “Comment définit-on le STOP?”; “Comment fait-on le dépistage du STOP?”. Accessed on 18 October 2026.
    Back to the text
  5. 5

    The tilt test (tilt table) is not essential but can help with the diagnosis, in particular when the standing test is normal despite a strong suspicion, when other disorders are suspected or when the person cannot stand for 10 minutes; it is often carried out in specialist centres.

    Expert consensus · checked on 18 October 2026

    Back to the text
  6. 6

    Before POTS is diagnosed, other causes of a faster heart rate when standing must be ruled out, including dehydration or blood loss, anaemia, hyperthyroidism or another hormonal disorder (for example of the adrenal glands), fever, infection, pain, the effects of medicines or drugs, prolonged bed rest, or panic attacks and severe anxiety.

    Expert consensus · checked on 18 October 2026

    Back to the text
  7. 7

    Basic tests look for secondary causes: haemoglobin, electrolytes, kidney function, ferritin, thyroid-stimulating hormone (TSH) and morning cortisol; other tests are guided by the initial assessment.

    Expert consensus · checked on 18 October 2026

    Back to the text
  8. 8

    Apart from the electrocardiogram, more extensive cardiac or neurological tests are not recommended routinely: they are guided by the initial assessment.

    Expert consensus · checked on 18 October 2026

    Back to the text
  9. 9

    To date, no treatment makes POTS go away; the goals described are informing the person, relieving symptoms, and improving physical fitness and quality of life. No treatment is effective for everyone.

    Established fact · checked on 18 October 2026

    Back to the text
  10. 10

    Management generally begins with information for the person affected, described as a key element, and with non-drug measures.

    Recommendation · checked on 18 October 2026

    Back to the text
  11. 11

    Finding what works can take time, and several approaches, including several medicines, are often combined.

    Expert consensus · checked on 18 October 2026

    Back to the text
  12. 12

    Medicines that can worsen orthostatic tachycardia are, where possible, stopped or replaced after the doctor has reviewed the person's treatments.

    Recommendation · checked on 18 October 2026

    Back to the text
  13. 13

    Increasing water and salt intake is among the measures described to increase blood volume, but the real benefit and the optimal salt intake remain to be established; the HAS limits added salt to people without high blood pressure, heart failure or kidney failure.

    Recommendation · checked on 18 October 2026

    HRS class IIb recommendation based on expert opinion (level E); small studies according to the CMAJ. The amounts differ between sources and are deliberately not included.

    Back to the text
  14. 14

    Lower-body compression garments reaching up to the waist, with or without abdominal compression, limit the shift of blood towards the lower body when standing; a 2021 randomised crossover trial, carried out during a tilt test, showed a reduction in orthostatic tachycardia, with compression of the abdomen and legs appearing more effective than compression of the legs alone.

    Recommendation · checked on 18 October 2026

    The 2021 trial measures an effect during the tilt test.

    Back to the text
  15. 15

    A regular, structured, progressive and supervised exercise programme is among the recommended forms of management: it starts with exercises that are not done standing (rowing machine, recumbent bike, swimming) before gradually moving on to upright exercise. People may feel worse at first, and improvement may not appear for a month.

    Recommendation · checked on 18 October 2026

    HRS class IIa recommendation (level of evidence B-R); small studies.

    Back to the text
  16. 16

    Limiting the factors that bring on symptoms (dehydration, sudden changes of position, prolonged standing, hot environments, large meals, alcohol) is among the measures described.

    Expert consensus · checked on 18 October 2026

    Back to the text
  17. 17

    For moments when a person feels about to faint, the NHS describes manoeuvres such as lying down with the legs raised or, if this is not possible, crossing the legs, rocking up onto the toes, tensing the buttock and stomach muscles or clenching the fists; the HAS describes contracting the leg muscles before standing up.

    Expert consensus · checked on 18 October 2026

    Back to the text
  18. 18

    Medicines may be considered if symptoms are severe from the outset or persist despite non-drug measures; most aim to slow the heart or reduce sympathetic activity, to constrict blood vessels, or to increase blood volume.

    Expert consensus · checked on 18 October 2026

    Back to the text
  19. 19

    Evidence for the effectiveness of the medicines used in POTS is limited: no large multicentre randomised trial has been conducted, and no medicine is approved specifically for POTS in North America.

    Expert consensus · checked on 18 October 2026

    The HRS 2015 recommendations on medicines are class IIb (uncertain benefit). Authorisation status in Switzerland and France has not been checked.

    Back to the text
  20. 20

    The Heart Rhythm Society and the Canadian Cardiovascular Society advise against sinus node ablation and other interventional treatments for POTS, owing to a lack of evidence of benefit and serious risks; regular intravenous saline infusions are not recommended routinely.

    Recommendation · checked on 18 October 2026

    HRS class III recommendations.

    Back to the text
  21. 21

    The initial assessment can be carried out in primary care or paediatrics, and a well-informed primary care doctor can coordinate care with other specialists. A multidisciplinary approach is described, which may involve doctors from several specialties (for example cardiology, neurology, gastroenterology), psychologists, nurses, physiotherapists and occupational therapists.

    Expert consensus · checked on 18 October 2026

    HRS recommendation for a multidisciplinary approach, class IIb, level E (expert opinion).

    Back to the text
  22. 22

    Referral to a specialist is considered if the initial measures do not help, if the person is very unwell, if the cause of the symptoms is unclear, or if the impact on social and working life is significant.

    Expert consensus · checked on 18 October 2026

    Back to the text
  23. 23

    Conditions associated with POTS also need to be treated in order to improve quality of life, which often requires a specialist's opinion.

    Expert consensus · checked on 18 October 2026

    Back to the text
  24. 24

    For adolescents, doctors at the HUG (Geneva University Hospitals) stress the importance of not trivialising the complaint and of naming the syndrome, of involving parents early, of helping the young person stay in school with the local network, and of addressing any associated anxiety or depression (psychotherapy may be necessary), as well as the crucial role of physiotherapy.

    Expert consensus · checked on 18 October 2026

    Authors' opinion in a continuing medical education article, not a recommendation from a professional society.

    Back to the text
  25. 25

    The medical history covers in particular how long the symptoms have been present, possible triggering factors and events, the severity of the symptoms, what makes them better or worse, physical activity, the impact on daily life, medicines and supplements, water and salt intake, and family history.

    Expert consensus · checked on 18 October 2026

    Back to the text
  26. 26

    Consensus definitions require a sustained increase in heart rate of at least 30 beats per minute within 10 minutes of moving to a standing position (or during a tilt test), without orthostatic hypotension, with frequent symptoms of orthostatic intolerance when standing that improve quickly when lying down, and in the absence of another cause that could explain the faster heart rate.

    Expert consensus · checked on 18 October 2026

    The HRS 2015 definition refers to standing for more than 30 seconds, with no 10-minute window and no minimum duration of symptoms, and defines orthostatic hypotension as a fall of more than 20 mm Hg in systolic pressure; the CMAJ and the HAS use a fall of at least 20/10 mm Hg.

    Back to the text
  27. 27

    POTS can severely limit functional capacity, schooling or work, and reduce quality of life.

    Established fact · checked on 18 October 2026

    Back to the text