Skip to content
Inciteful Med

The Roadmap to Diagnosis: Testing and Criteria

Last updated:

A POTS diagnosis requires a sustained heart rate increase of at least 30 bpm (40 bpm for adolescents) within 10 minutes of standing, without a significant drop in blood pressure. Diagnosis involves a 10-minute active stand test or a tilt table test, plus bloodwork to rule out other conditions.

Key Takeaways

  • • Adults need a sustained heart rate increase of 30 bpm or more within 10 minutes of standing to be diagnosed with POTS.
  • • Adolescents require a 40 bpm or greater heart rate increase to meet the diagnostic criteria for POTS.
  • • Unlike orthostatic hypotension, POTS does not cause a significant drop in blood pressure upon standing.
  • • Clinical diagnosis usually involves a 10-minute active stand test (NASA Lean Test) or a head-up tilt table test (HUTT).
  • • Doctors must run basic blood tests and cardiac evaluations to rule out conditions that mimic POTS, such as anemia or thyroid disorders.

Getting a diagnosis for POTS requires more than just noting a fast heart rate. Because many different conditions can cause a racing heart, doctors use specific “gold standard” tests and a process of elimination to ensure the diagnosis is accurate [1][2].

The Diagnostic Criteria

The hallmark of POTS is an excessive increase in heart rate when moving from lying down to standing, without a significant drop in blood pressure [3][4].

  • For Adults (19+): Your heart rate must increase by at least 30 beats per minute (bpm) within 10 minutes of standing [3][5].
  • For Adolescents (under 19): Because younger hearts naturally beat faster, the required increase is at least 40 bpm [6][7].
  • The “Sustained” Rule: This increase must be sustained. This means it isn’t just a brief spike upon standing that quickly returns to normal. The heart rate must remain elevated for the duration of the standing period [8][9].

POTS vs. Orthostatic Hypotension (OH)

A critical part of the diagnosis is ruling out Orthostatic Hypotension (OH). In OH, your blood pressure drops significantly when you stand (usually a drop of 20 mmHg or more in systolic pressure) [10][11]. In POTS, the blood pressure typically stays stable or even rises slightly; it is the heart rate alone that is overreacting to the change in position [10][4].

What to Expect During Testing

There are two primary ways doctors test for POTS. Both require you to be still and quiet to get an accurate baseline. Many patients also track their own data at home before seeing a specialist using what is sometimes called the “Poor Man’s Tilt Table Test”—an active stand test done at home using a standard blood pressure cuff and pulse oximeter [12].

1. The 10-Minute Active Stand Test (NASA Lean Test)

This is a simple, effective test often done in a clinic.

  • Preparation: You will lie flat on your back for at least 10 minutes so your heart rate and blood pressure reach a resting state [13][14].
  • The Stand: You will stand up and lean your shoulder blades against a wall, keeping your feet about 6 inches away from the wall and your arms at your sides [15][13].
  • Monitoring: The doctor or nurse will measure your heart rate and blood pressure every minute for 10 full minutes while asking about your symptoms [15][13].

2. The Head-Up Tilt Table Test (HUTT)

This is performed in a specialized lab.

  • The Setup: You are strapped securely to a motorized table while lying flat.
  • The Tilt: The table is tilted upward (usually to 60–70 degrees) so you are almost standing, but your leg muscles aren’t working to keep you up [16][11].
  • The Goal: By removing the “muscle pump” of the legs, the test puts maximum stress on your autonomic nervous system to see how it responds [17].
  • Important Warning: The HUTT can be deeply uncomfortable and may trigger a severe POTS flare, fainting, or intense nausea. It is highly recommended that you arrange a ride home and do not plan to go back to work or school afterward [16].

Completeness Checklist: Ruling Out Mimics

Because POTS symptoms can “mimic” other serious conditions, your doctor should run several tests to ensure nothing else is being missed [18][1].

Test Category What It Rules Out
CBC (Complete Blood Count) Anemia (low iron/red blood cells), which can cause a fast heart rate and fatigue [18][1].
TSH (Thyroid Stimulating Hormone) Hyperthyroidism, which can cause heart palpitations and heat intolerance [18][12].
Metanephrines (Blood or Urine) Pheochromocytoma, a rare adrenal tumor that causes surges of adrenaline and high blood pressure [18][1].
EKG & Echocardiogram Structural heart disease or primary heart rhythm disorders [1][19].
CMP (Comprehensive Metabolic Panel) Electrolyte imbalances or kidney/liver issues that could cause dizziness [18].
Morning Cortisol Adrenal insufficiency (Addison’s disease), which causes low blood pressure and fatigue [18].

If these tests are normal and you meet the heart rate criteria, it reinforces the diagnosis of POTS.

Frequently Asked Questions

What is the official diagnostic criteria for POTS?
For adults, a POTS diagnosis requires a sustained heart rate increase of at least 30 beats per minute within 10 minutes of standing. For adolescents under 19, the required increase is at least 40 beats per minute. This must occur without a significant drop in blood pressure.
What is the difference between POTS and orthostatic hypotension?
In orthostatic hypotension, blood pressure drops significantly when you stand up. In POTS, blood pressure remains stable or slightly rises, and only the heart rate excessively increases in response to the change in position.
What happens during a tilt table test for POTS?
During a tilt table test, you lie flat on a motorized table that is then tilted upward to 60 or 70 degrees. This removes the muscle pumping action in your legs, putting maximum stress on your autonomic nervous system to measure how your heart rate and blood pressure respond to gravity.
Can I test for POTS at home?
Many patients track their symptoms at home using an active stand test, sometimes called the poor man's tilt table test. This involves using a blood pressure cuff and pulse oximeter to measure your heart rate and blood pressure while lying flat, and then every minute for 10 minutes after standing up.
What other conditions mimic POTS symptoms?
Several conditions can cause a fast heart rate and dizziness similar to POTS. Before making a final diagnosis, doctors usually run blood tests and EKGs to rule out anemia, thyroid issues like hyperthyroidism, adrenal gland problems, and structural heart disease.

Questions for Your Doctor

  • • Can we perform a 10-minute active stand test (NASA Lean Test) or a Tilt Table Test to document my heart rate changes?
  • • Have we ruled out orthostatic hypotension by checking if my blood pressure drops significantly when I stand?
  • • Which specific labs (like TSH, CBC, or metanephrines) should we run to make sure my symptoms aren't caused by a 'mimic' condition?
  • • Does my heart rate increase meet the 'sustained' criteria, or was it just a temporary spike?
  • • Should I have an echocardiogram or EKG to rule out structural heart issues before finalizing a POTS diagnosis?

Questions for You

  • • When you stand up, do you feel an immediate 'thumping' in your chest or a lightheadedness that gets worse the longer you stay upright?
  • • Have you noticed if your heart rate settles down quickly when you sit or lie back down?
  • • Do you have any 'red flag' symptoms like fainting (syncope), or do you mostly experience 'near-fainting' (presyncope)?
  • • Are you currently taking any medications, such as stimulants for ADHD or certain allergy meds, that might be making your heart beat faster?

Want personalized information?

Type your question below to get evidence-based answers tailored to your situation.

References

  1. 1

    Recognizing postural orthostatic tachycardia syndrome.

    Pavlik D, Agnew D, Stiles L, Ditoro R

    JAAPA : official journal of the American Academy of Physician Assistants 2016; (29(4)):17-23 doi:10.1097/01.JAA.0000481398.76099.09.

    PMID: 26967958
  2. 2

    Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance.

    Raj SR, Guzman JC, Harvey P, et al.

    The Canadian journal of cardiology 2020; (36(3)):357-372 doi:10.1016/j.cjca.2019.12.024.

    PMID: 32145864
  3. 3

    Postural Orthostatic Tachycardia Syndrome and Its Unusual Presenting Complaints in Women: A Literature Minireview.

    Anjum I, Sohail W, Hatipoglu B, Wilson R

    Cureus 2018; (10(4)):e2435 doi:10.7759/cureus.2435.

    PMID: 29876157
  4. 4

    Postural Orthostatic Tachycardia Syndrome: Mechanisms and New Therapies.

    Mar PL, Raj SR

    Annual review of medicine 2020; (71()):235-248 doi:10.1146/annurev-med-041818-011630.

    PMID: 31412221
  5. 5

    Use of Ivabradine in the Treatment of Patients with Postural Orthostatic Tachycardia Syndrome (POTS): A Systematic Review.

    Melo APG, Moretti MA, Chagas ACP

    Arquivos brasileiros de cardiologia 2025; (122(11)):e20250347 doi:10.36660/abc.20250347.

    PMID: 41538594
  6. 6

    Update of Individualized Treatment Strategies for Postural Orthostatic Tachycardia Syndrome in Children.

    Zhang Q, Xu B, Du J

    Frontiers in neurology 2020; (11()):525 doi:10.3389/fneur.2020.00525.

    PMID: 32655482
  7. 7

    Recent advances in the understanding of the mechanisms underlying postural tachycardia syndrome in children: practical implications for treatment.

    Zheng X, Chen Y, Du J

    Cardiology in the young 2017; (27(3)):413-417 doi:10.1017/S1047951116002559.

    PMID: 27938459
  8. 8

    Postural orthostatic tachycardia syndrome in primary care: diagnosis, treatment and a case of African-American man presenting with POTS.

    Del Pozzi AT, Enechukwu M, Blitshteyn S

    BMJ case reports 2019; (12(9)) doi:10.1136/bcr-2019-229824.

    PMID: 31537586
  9. 9

    A Case Report and Review of Postural Orthostatic Tachycardia Syndrome in Pregnancy.

    Lide B, Haeri S

    AJP reports 2015; (5(1)):e33-6 doi:10.1055/s-0034-1544106.

    PMID: 26199795
  10. 10

    Systematic literature review: treatment of postural orthostatic tachycardia syndrome (POTS).

    Schiweck N, Langer K, Maier A, et al.

    Clinical autonomic research : official journal of the Clinical Autonomic Research Society 2026; (36(1)):3-16 doi:10.1007/s10286-025-01172-2.

    PMID: 41225175
  11. 11

    Tilt Test: A Review.

    Aponte-Becerra L, Novak P

    Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society 2021; (38(4)):279-286 doi:10.1097/WNP.0000000000000625.

    PMID: 34009851
  12. 12

    Dysautonomia: a common comorbidity of systemic disease.

    Blitshteyn S

    Immunologic research 2025; (73(1)):105 doi:10.1007/s12026-025-09661-2.

    PMID: 40624434
  13. 13

    Normative data for the 10-min lean test in adults without orthostatic intolerance.

    Iftekhar N, Wilson A, Nguty L, et al.

    Frontiers in neurology 2025; (16()):1625216 doi:10.3389/fneur.2025.1625216.

    PMID: 41111962
  14. 14

    Feasibility, reliability and safety of self-assessed orthostatic blood pressure at home.

    Gibbon JR, Parry SW, Witham MD, et al.

    Age and ageing 2022; (51(7)) doi:10.1093/ageing/afac153.

    PMID: 35776671
  15. 15

    Hemodynamics during the 10-minute NASA Lean Test: evidence of circulatory decompensation in a subset of ME/CFS patients.

    Lee J, Vernon SD, Jeys P, et al.

    Journal of translational medicine 2020; (18(1)):314 doi:10.1186/s12967-020-02481-y.

    PMID: 32799889
  16. 16

    Cerebral Perfusion Monitoring Using Near-Infrared Spectroscopy During Head-Up Tilt Table Test in Patients With Orthostatic Intolerance.

    Kim YH, Paik SH, V ZP, et al.

    Frontiers in human neuroscience 2019; (13()):55 doi:10.3389/fnhum.2019.00055.

    PMID: 30837856
  17. 17

    The prevalence and impact of orthostatic intolerance in young women across the hypermobility spectrum.

    Peebles KC, Tan I, Butlin M, et al.

    American journal of medical genetics. Part A 2022; (188(6)):1761-1776 doi:10.1002/ajmg.a.62705.

    PMID: 35224842
  18. 18

    Postural Orthostatic Tachycardia Syndrome: JACC Focus Seminar.

    Bryarly M, Phillips LT, Fu Q, et al.

    Journal of the American College of Cardiology 2019; (73(10)):1207-1228 doi:10.1016/j.jacc.2018.11.059.

    PMID: 30871704
  19. 19

    Postural orthostatic tachycardia syndrome following open thoracoabdominal aortic aneurysm repair.

    Manuel L, Fong LS, Mamo A, et al.

    Journal of surgical case reports 2021; (2021(2)):rjab012 doi:10.1093/jscr/rjab012.

    PMID: 33623665

This page explains POTS diagnostic criteria and testing for educational purposes only. Always consult a healthcare provider or dysautonomia specialist for a formal medical evaluation and diagnosis.

Stay up to date

Get notified when new research about Postural Orthostatic Tachycardia Syndrome (POTS) is published.

No spam. Unsubscribe anytime.