What to Expect During a POTS Evaluation

Do you feel lightheaded or exhausted after standing? Perhaps you sweat profusely or get heart palpitations while standing. These symptoms could be a sign of postural orthostatic tachycardia syndrome (POTS), a form of dysautonomia. 

Our multidisciplinary team at Delaware NeuroRehab in Dover, Delaware, evaluates symptoms like these to diagnose or rule out POTS. Although POTS can be challenging to diagnose, diagnostic evaluations offer insight into what causes your symptoms and what you can do to alleviate them. 

POTS can stem from small-fiber nerve damage, elevated stress hormones, or from another condition like lupus or Lyme disease. It can also present similarly to conditions like fibromyalgia. A comprehensive evaluation is your first step toward identifying POTS and accessing the proper care. 

Understanding POTS

POTS and other forms of dysautonomia stem from an underlying issue with your autonomic nervous system — the part of the nervous system that controls involuntary body functions like your heart rate and blood pressure. 

When you stand up after sitting, gravity pulls your blood downward toward your legs. To ensure your brain gets the blood it needs, your autonomic nervous system springs into action by tightening blood vessels and increasing your heart rate. This response helps your brain get sufficient oxygen. 

However, if you have POTS, this response is faulty. As you continue standing upright, blood travels downward and evades your brain. You might experience increased or decreased blood pressure as a result. 

Recognizing POTS symptoms

When you have POTS, standing up sets off a chain reaction involving your heart, blood vessels, brain, and nerves. Symptoms can vary but might include:

• Intense or long-lasting fatigue
• Lightheadedness and possible fainting
• A pounding or palpitating heart 
• Headaches
• Tremors or shakiness
• Exercise intolerance

You might notice symptoms worsen under some circumstances, like when you’re sick with a cold or outside in the heat. 

Diagnostic evaluations for POTS

When evaluating for POTS, our Delaware NeuroRehab team considers your symptoms and the results of a physical exam. There are specific tests to help identify POTS, including:

Tilt test

A tilt test is the primary testing strategy for POTS. During this test, you lay flat on a table. The team slowly tilts the table so you are nearly vertical while measuring your heart rate, blood oxygen, and blood pressure. 

The tilt test results indicate you have POTS if you exhibit an abnormal heart rate response to being tilted upright, have increased symptoms while upright, and don’t develop orthostatic hypotension during the first three minutes. Orthostatic hypotension is a drop in blood pressure that happens within three minutes of standing up. 

Quantitative sudomotor axon reflex test (QSART)

QSART evaluates the response of certain autonomic nerves, specifically those that regulate sweating. 

Valsalva maneuver

The Valsalva maneuver involves pushing out as much air as possible, which can reduce a fast heart rhythm. In a diagnostic evaluation for POTS, the Valsalva maneuver can help test autonomic nerves that control your heart. 

Other tests include autonomic breathing tests and blood and urine tests to rule out other causes of your symptoms. 

Managing POTS: Your next steps

Delaware NeuroRehab specializes in helping you manage POTS through multidisciplinary neurorehabilitation. Our team’s recommendations vary based on your symptoms. In many cases, you can manage POTS without pharmacological treatment. 

If you experience symptoms consistent with POTS, don’t hesitate to get in touch. Call Delaware NeuroRehab or request an appointment online for a diagnostic evaluation.