Who in St. Louis should I see for a Postural Orthostatic Tachycardia Syndrome (POTS) evaluation?

POTS Evaluation in St. Louis: Specialist Recommendations

For a Postural Orthostatic Tachycardia Syndrome (POTS) evaluation in St. Louis, you should see a cardiologist who specializes in autonomic disorders at a dedicated autonomic function laboratory. 1

Understanding POTS Evaluation Requirements

POTS requires specialized testing that includes:

1. A 10-minute active stand test to assess heart rate and blood pressure changes
2. Beat-to-beat hemodynamic monitoring
3. Possibly additional autonomic function testing

According to the American College of Cardiology guidelines, proper POTS diagnosis requires documenting:

• Heart rate increase of >30 beats/min (or >40 beats/min in those 12-19 years old) within 10 minutes of standing
• Absence of orthostatic hypotension (no significant BP drop)
• Symptoms of orthostatic intolerance 1

Recommended Evaluation Process

The evaluation should be performed in a dedicated autonomic laboratory with:

• Temperature-controlled environment (21-23°C)
• Testing performed before noon
• Patient fasted for 3 hours prior
• Avoidance of caffeine, nicotine and other stimulants on test day 1

What to Expect During Evaluation

The cardiologist will likely perform:

1. Basic laboratory testing (CBC, metabolic panel, cardiac biomarkers)
2. ECG
3. Echocardiogram
4. Ambulatory rhythm monitoring
5. Active stand test or tilt table testing with continuous BP and HR monitoring 1

Red Flags That Require More Extensive Evaluation

Be aware that certain factors warrant a more extensive workup:

• Older age at onset
• Male gender
• Prominent syncope
• Abnormal neurological examination
• Symptoms refractory to first-line treatments 2

Importance of Proper Diagnosis

Proper diagnosis is crucial as POTS can significantly impact quality of life and may be associated with:

• Fatigue and exercise intolerance
• Cognitive difficulties ("brain fog")
• Gastrointestinal symptoms
• Headaches
• Sleep disturbances 3, 4

Early and accurate diagnosis leads to better management strategies and improved outcomes in terms of symptom control and quality of life.