Clinical Definition or Criteria to Diagnose POTS

To make a diagnosis of OH (NMH) or POTS, a certain set of conditions or criteria need to be met. This set of criteria has been set as guidelines by the physician specialists in cardiology and neurology.

The definition does not require special testing to get the information about blood pressure, pulse and symptoms. The information can be collected in the physician's office or through a clinical study like a tilt table test.

Criteria:

First,a person lies down for 5-20 minutes. Then the blood pressure and pulse are taken lying down. Then, they stand up. A person is thought to have POTS if  in the first 10 minutes after standing the following 2 things happen: ^1,2
    •  their heart rate goes up at least 30 beats per minute OR it goes higher than 120 beats per minute AND
    •  they get orthostatic symptoms.

This is the criteria used for adults. Some of the studies suggest that the heart rate may be higher with children and adolescents who have POTS.

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Some will call it "mild orthostatic intolerance' if the heart beat goes up more than 30 beats but it doesn't get to 120 bpm⁶.

BP changes: The blood pressure may stay the same, have a small decrease or there might be a small increase.⁷

Some believe other factors should be considered:
 »  The person is not on any medication that would affect the vascular or autonomic tone³
 »  The person has not been on prolonged bedrest.³
 »  The person should have had symptoms for more than 3 months.¹
 »  Other autonomic symptoms that may be present: abnormal sweating, altered ability to regulate body temperature and changes in the bowel and bladder function.¹

 

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References

1. Grubb BP. Postural tachycardia syndrome. Circulation. 2008;117:2814–2817. Abstract. Article PDF.
2. Medow MS, Stewart JM, Sanyal S, Mumtaz A, Stca D and Frishman WH. Pathophysiology, Diagnosis, and Treatment of Orthostatic Hypotension and Vasovagal Syncope. Cardiology in Review 2008;16(1):4-20. Abstract
3. Grubb BP, Row P, Calkins H. Postural tachycardia, orthostatic intolerance and the chronic fatigue syndrome. In: Grubb BP, Olshansky B, eds. Syncope: Mechanisms and Management 2nd Ed. Malden, Mass: Blackwell/ Future Press; 2005:225–244.
4. Thieben MJ, Sandroni P, Sletten DM, et al. Postural orthostatic tachycardia syndrome: The Mayo Clinic experience. Mayo Clin Proc. 2007;82:308–313. Abstract. Article PDF.
5. Moya, Guidelines for the diagnosis and management of syncope (version 2009). European Heart Journal (2009); 30: 2631-2671. Abstract. Article PDF.
6. Low PA, Sandroni P, Joyner and Shen W. Postural Tachycardia Syndrome (POTS). J Cardopvasc Electrophysiology 2009; 20:352-358.  Abstract.  Article PDF
7. Low P, Opfer-Gehrking T, Textor S, Benarroch E, Shen W, Schondorf R, Suarez G,Rummans T. Postural tachycardia syndrome (POTS). Neurology. 1995;45:519–525. Abstract.

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