Postural Orthostatic Tachycardia Syndrome is a real, recognised condition — yet many people wait years for a diagnosis. This site explains what PoTS is, how to get diagnosed, and how to manage it, based on current evidence and NHS guidelines.
This site is written for three different readers
Learn about the symptoms, understand what the diagnostic tests involve, and find out how to approach your GP with confidence.
Start here → Diagnosed patientsExplore management strategies, medications, exercise programmes, lifestyle adjustments, and how to navigate work and benefits.
Managing PoTS → CliniciansClinical diagnostic criteria, referral thresholds, prescribing considerations, and a summary of current evidence — with full references.
Clinician resources →PoTS is a form of dysautonomia — a disorder of the autonomic nervous system — characterised by an abnormal increase in heart rate on standing, accompanied by symptoms of orthostatic intolerance.
When a person with PoTS stands up, blood pools in the lower body and the autonomic nervous system fails to compensate adequately. The heart races to try to maintain blood pressure and circulation to the brain, producing a wide range of debilitating symptoms.[3]
PoTS is not a single disease but a syndrome with several recognised subtypes, including neuropathic, hyperadrenergic, and hypovolaemic forms, each with distinct underlying mechanisms and treatment implications.[4]
Read the full explanationSustained heart rate rise of ≥30 bpmWithin 10 minutes of standing or head-up tilt (≥40 bpm in adolescents aged 12–19). Heart rate typically exceeds 120 bpm.[3]
Absence of orthostatic hypotensionBlood pressure does not fall by ≥20/10 mmHg on standing — distinguishing PoTS from classical orthostatic hypotension.[3]
Symptoms of orthostatic intolerancePresent for ≥3 months: dizziness, palpitations, presyncope, fatigue, cognitive dysfunction, and others that worsen on standing.[5]
No other causative conditionSymptoms are not better explained by another condition, medication effect, or physiological state such as dehydration.[3]
Symptoms are typically worse on standing and improve when lying down. They vary considerably between individuals and fluctuate day to day.[5]
Each section is written in plain language and fully referenced to current guidelines and published research.
The NASA lean test, tilt table testing, referral pathways, and how to approach your GP.
Diagnosis →Neuropathic, hyperadrenergic, and hypovolaemic subtypes — what they mean and why it matters.
Understanding →Non-pharmacological first steps and an overview of medications used in PoTS management.
Treatment →The evidence-based PoTS exercise programme and how to build activity safely.
Management →Why sodium and fluid intake matter in PoTS, and practical guidance on quantities.
Management →PIP eligibility, reasonable workplace adjustments, and driving guidance for PoTS patients.
Practical →The significant overlap between PoTS and hypermobile Ehlers-Danlos Syndrome.
Related conditions →Understanding the symptomatic and mechanistic overlap between these two conditions.
Related conditions →Post-COVID autonomic dysfunction and how it relates to the broader PoTS picture.
Related conditions →This section is written for GPs, cardiologists, neurologists, and allied health professionals. It covers diagnostic algorithms, prescribing considerations, referral thresholds, and a summary of the current evidence base — with full academic references throughout.
Access clinician resourcesNASA lean test protocol, tilt table interpretation, and how to differentiate PoTS subtypes in primary care.
Evidence review of ivabradine, fludrocortisone, midodrine, propranolol, and pyridostigmine — including off-label considerations.
When to refer, to whom, and what to include in a referral letter — with UK autonomic clinic directory.
Screening for hEDS, ME/CFS, autoimmune dysautonomia, and mast cell activation syndrome in PoTS patients.
A monthly digest of new research, clinical guidance updates, and patient news. Summaries are AI-assisted and link to original sources. Always discuss new research with your clinical team before making changes to your management.
View all research updatesNew recommendations on initial assessment and referral pathways — relevant to PoTS diagnosis in community settings.
A comparative study of two commonly used agents, with implications for first-line pharmacological choice.
Growing evidence that post-COVID PoTS may have distinct features requiring tailored approaches.