Key Symptoms and Tests You Need to Know

If you have dizzy spells frequently or experience tachycardia when standing upright, you are probably experiencing some form of postural orthostatic tachycardia syndrome (POTS). In this kind of dysautonomia, patients experience inappropriately altered blood flow due to maladaptive responses from their autonomic nervous system. They suffer debilitating and debilitating symptoms as a result that can drastically hinder daily living.

The diagnosis of POTS may be relatively tough because symptoms overlap with different syndromes, there is a need to identify the main signs and the appropriate tests. In this guide, we will discuss the symptoms of POTS and the essential diagnostic tests that healthcare professionals use. By knowing these, you shall be able to take the right steps towards health management.

What Are POTS? Understanding the Basics

Postural Orthostatic Tachycardia Syndrome is a condition in which your body has a problem with regulating the flow of blood and heart rate, especially when you switch from being seated or lying down to standing. It belongs to a more inclusive class of disorders known as dysautonomia, referring to any disorders affecting the autonomic nervous system, the system controlling involuntary functions such as heart rate, blood pressure, and digestion.

In patients with POTS, it is rather challenging for the body to appropriately regulate blood flow upon standing; it causes a sudden surge of heartbeats that are often 30+ beats per minute within 10 minutes and other symptoms such as dizziness and fatigue. Although the condition is real and disables so many people, it is still underdiagnosed or missed, because its symptoms mimic anxiety, chronic fatigue syndrome, or some other cardiovascular disease. Raising awareness about this condition is key to ensuring timely diagnosis and proper treatment.

Key Symptoms of POTS: What to Watch For

Early diagnosis and management of POTS depend on identifying its symptoms. Symptoms vary in severity, can be quite debilitating, and frequently mimic other disorders, making the Step-by-Step Process to Getting Diagnosed with POTS essential. Tracking symptoms over time, consulting a specialist familiar with autonomic disorders, and undergoing key tests like the Tilt Table Test or Active Stand Test can help confirm the condition. Since POTS is often misdiagnosed, persistence and self-advocacy play a crucial role in receiving proper treatment and improving quality of life.

Common Symptoms That May Indicate POTS

POTS symptoms can vary widely, but some of the most common signs include:

• Dizziness or lightheadedness when standing up – Many people with POTS feel faint or unsteady upon standing due to poor blood circulation.
• Rapid heartbeat (tachycardia) upon standing – A key characteristic of POTS is an abnormally fast heart rate increase (30+ beats per minute in adults, 40+ in teens) when transitioning to an upright position.
• Extreme fatigue and brain fog – Persistent exhaustion and difficulty concentrating are common, making daily tasks feel overwhelming.
• Nausea, digestive issues, and temperature regulation problems – Some individuals experience bloating, gastroparesis (delayed stomach emptying), or an inability to tolerate heat and cold.
• Exercise intolerance and difficulty standing for long periods – Physical activity can worsen symptoms, and prolonged standing may lead to dizziness or fainting.

Why POTS Symptoms Vary Between Individuals

POTS doesn’t present the same way in everyone. While some people experience mild discomfort, others face severe, life-altering symptoms that interfere with work, school, and daily activities.

• Symptoms can fluctuate daily, with some days feeling manageable and others completely debilitating.
• Triggers like heat, stress, dehydration, or prolonged standing can worsen symptoms, making management unpredictable.

Overlapping Conditions That Can Make Diagnosis Difficult

Because POTS symptoms mimic those of other medical conditions, many individuals struggle for years before receiving a correct diagnosis.

• POTS shares symptoms with conditions like anxiety disorders, chronic fatigue syndrome (ME/CFS), fibromyalgia, and migraines, leading to frequent misdiagnosis.
• Some doctors mistake it for panic attacks, dehydration, or low blood pressure, delaying proper treatment.

Understanding these symptoms and how they manifest differently in each person is crucial for getting the right diagnosis and care.

How to Diagnose POTS: Essential Tests and Evaluations

Getting an accurate diagnosis for Postural Orthostatic Tachycardia Syndrome (POTS) can be a long and frustrating process. Many people struggle with unexplained symptoms for years before discovering the root cause. Since POTS shares symptoms with several other conditions, proper testing and evaluation are essential to distinguish it from other disorders. In this section, we’ll explore the key steps involved in diagnosing POTS, from tracking symptoms to undergoing specialized medical tests.

The First Steps in Getting a POTS Diagnosis

Before undergoing formal medical tests, it’s important to document your symptoms and seek a knowledgeable healthcare provider.

Tracking Symptoms Over Time

Since POTS symptoms can fluctuate daily, keeping a detailed record is one of the most helpful things you can do. You should note:

• When symptoms occur (morning, after meals, during hot weather, etc.)
• Triggers that worsen symptoms (standing, exercise, dehydration, stress)
• The severity of symptoms (mild discomfort vs. debilitating episodes)
• Additional symptoms like nausea, temperature intolerance, or brain fog

This symptom log can provide valuable insight for your doctor and help guide further testing.

Finding the Right Doctor

Not all doctors are familiar with autonomic nervous system disorders, making it essential to find a cardiologist, neurologist, or dysautonomia specialist who understands POTS. Many general practitioners may misdiagnose it as anxiety, panic disorder, or simple dehydration due to a lack of awareness.

If your doctor is unfamiliar with POTS, you may need to advocate for yourself, request referrals, or seek second opinions to get the right diagnosis.

Medical Tests Used to Diagnose POTS

Once you find a knowledgeable doctor, they will use a series of tests to confirm whether you have POTS. These tests evaluate how your heart rate and blood pressure respond to changes in posture and help rule out other conditions.

Tilt Table Test – The Gold Standard for Diagnosing POTS

The tilt table test is considered the most reliable diagnostic tool for POTS. It measures how your heart rate and blood pressure respond when you move from a lying-down position to an upright one.

How the test works:

1. The patient lies flat on a motorized table.
2. The table is slowly tilted upright to about 60–70 degrees.
3. Heart rate and blood pressure are monitored for 10–45 minutes.

POTS Diagnosis Criteria:

• An increase of 30+ beats per minute (BPM) in adults or 40+ BPM in adolescents (ages 12–19) within 10 minutes of standing without a significant drop in blood pressure confirms POTS.

Because this test simulates real-life POTS symptoms, some patients may feel lightheaded or unwell during it.

Active Stand Test – A Simpler Alternative

If a tilt table test is unavailable, doctors may perform an active stand test, which can be done in a clinic or at home.

How the test works:

1. The patient lies down for 5–10 minutes while their baseline heart rate and blood pressure are recorded.
2. They stand up and remain still for 10 minutes while their heart rate and blood pressure are monitored.

POTS Diagnosis Criteria:

• A heart rate increase of 30+ BPM in adults or 40+ BPM in teens within 10 minutes suggests POTS.

This test is less controlled than a tilt table test but still effective for diagnosing POTS, especially in clinics without specialized equipment.

24-Hour Heart Rate Monitoring

Some doctors may recommend 24-hour heart rate monitoring using a Holter monitor or a wearable heart rate device. This test helps detect patterns of excessive heart rate fluctuations throughout the day, especially after standing up, eating, or exercising.

What this test helps with:

• Identifying heart rate spikes that are consistent with POTS.
• Ruling out arrhythmias or other heart-related conditions.
• Tracking how heart rate responds to daily activities.

Blood Tests to Rule Out Other Conditions

Since POTS symptoms overlap with many other disorders, doctors often conduct blood tests to rule out other potential causes before confirming a diagnosis.

Common blood tests include:

• Complete Blood Count (CBC) – Checks for anemia, which can cause dizziness and fatigue.
• Thyroid Function Tests – Detects thyroid disorders, which can mimic POTS symptoms.
• Vitamin B12 and Iron Levels – Low levels can contribute to fatigue and weakness.
• Cortisol Tests – Screens for adrenal gland dysfunction, which can affect blood pressure regulation.
• Autoimmune Panels – Identifies conditions like lupus or Sjögren’s syndrome, which can sometimes be linked to POTS.

If all these tests come back normal, and POTS symptoms persist, doctors will move forward with autonomic testing.

Why Many People Struggle to Get Diagnosed

Despite the clear criteria for diagnosing POTS, many patients experience delays in getting an accurate diagnosis. On average, it takes several years for a person with POTS to receive a proper diagnosis.

See Also

Lack of Awareness Among General Practitioners

Many primary care doctors are not trained to recognize dysautonomia, leading them to dismiss symptoms or misattribute them to anxiety or stress.

Misdiagnosis as Anxiety or Dehydration

Because symptoms like dizziness, rapid heartbeat, and shortness of breath can resemble panic attacks, many POTS patients are incorrectly diagnosed with anxiety disorders. Others may be told to simply drink more water or increase salt intake, without further testing.

The Need for Persistence and Self-Advocacy

Patients often have to push for proper testing, referrals, and second opinions to get an accurate diagnosis. If a doctor dismisses concerns, seeking out a specialist or requesting specific tests can make all the difference.

What to Do After a POTS Diagnosis

Receiving a POTS diagnosis can be overwhelming, but it also provides clarity and a path forward. While there’s no single cure for POTS, lifestyle adjustments, medical treatments, and support systems can help manage symptoms and improve quality of life. Here’s what you can do after being diagnosed to take control of your health.

Making Lifestyle Adjustments for Better Symptom Management

One of the most effective ways to manage POTS is by adopting daily habits that support blood flow, hydration, and overall well-being.

Increase Salt and Fluid Intake

Since POTS is linked to low blood volume and poor circulation, increasing salt (sodium) and water intake helps prevent dizziness and improve blood flow. Doctors often recommend:

• 2–3 liters of fluids per day, including water, electrolyte drinks, or broths.
• 3,000–10,000 mg of sodium per day, depending on individual needs (consult your doctor).

Wear Compression Garments

Compression socks or tights help prevent blood pooling in the legs and reduce symptoms like dizziness and fatigue. They improve circulation and support the autonomic nervous system.

Modify Exercise Routines

Many people with POTS experience exercise intolerance, but regular movement can help retrain the autonomic nervous system. Key strategies include:

• Starting with recumbent exercises (seated cycling, swimming, rowing) before progressing to upright activities.
• Focusing on strength training for the legs to improve blood circulation.
• Gradually increasing activity levels to avoid symptom flares.

Adjust Daily Activities

• Avoid prolonged standing—try sitting when possible or shifting weight frequently.
• Elevate your head while sleeping to reduce morning dizziness.
• Limit triggers like heat, stress, and caffeine, which can worsen symptoms.

Seeking Support from POTS Communities and Specialists

Living with POTS can feel isolating, but connecting with others who understand your condition can be incredibly helpful.

Find a Specialist

Since many doctors lack experience with POTS, seeking out a specialist can make a big difference in managing symptoms. Consider seeing:

• A cardiologist or electrophysiologist (for heart-related concerns).
• A neurologist (for autonomic nervous system dysfunction).
• A dysautonomia specialist (for comprehensive care).

Join POTS Support Groups

Online communities and support groups provide a safe space to share experiences, tips, and emotional support. Some popular platforms include:

• Dysautonomia International (forums, events, and medical resources).
• Facebook support groups for POTS patients.
• Reddit communities where people share symptom management tips.

Tracking Progress with Wearable Health Monitors

Since POTS symptoms fluctuate daily, using a wearable health monitor can help track heart rate, activity levels, and symptom patterns over time.

Benefits of Using a Wearable Device

• Monitor heart rate trends to identify triggers and warning signs.
• Track hydration and activity levels to optimize symptom management.
• Share data with doctors to fine-tune treatment plans.

Recommended Wearable Devices for POTS Patients

• Apple Watch – Tracks heart rate and offers alerts for unusual fluctuations.
• Garmin or Fitbit – Monitors heart rate, activity, and sleep patterns.
• Polar H10 Heart Rate Monitor – Provides precise heart rate tracking for exercise and daily monitoring.

Final Thoughts: Taking Charge of Your POTS Journey

Receiving a POTS diagnosis can feel overwhelming, but understanding your symptoms and knowing the right tests can empower you to take control of your health. While POTS can be challenging to manage, early diagnosis, lifestyle adjustments, and the right medical support can significantly improve your quality of life.

If you suspect you have POTS, tracking symptoms and seeking a knowledgeable doctor is the first step. Once diagnosed, hydration, dietary changes, exercise modifications, and wearable health monitors can help manage symptoms effectively. Additionally, connecting with POTS communities can provide emotional support and valuable insights from those on a similar journey.

Living with POTS requires patience, advocacy, and adaptation, but with the right strategies, many individuals find ways to regain stability and lead fulfilling lives. Stay informed, listen to your body, and remember—you are not alone in this journey.