Which specialist diagnoses Postural Orthostatic Tachycardia Syndrome (POTS)?

Diagnosing Postural Orthostatic Tachycardia Syndrome (POTS)

Cardiologists are the primary specialists who diagnose Postural Orthostatic Tachycardia Syndrome (POTS), though autonomic neurologists may also be involved in the diagnostic process. 1

Diagnostic Process

The diagnosis of POTS requires specific criteria as defined by the American College of Cardiology and American Heart Association:

1. Heart rate increase criteria:

   • ≥30 beats per minute (bpm) within 10 minutes of standing (for adults)
   • ≥40 bpm within 10 minutes of standing (for individuals aged 12-19 years) 2, 1

2. Other required criteria:

   • Absence of orthostatic hypotension (no sustained systolic blood pressure drop ≥20 mmHg)
   • Frequent symptoms of orthostatic intolerance during standing
   • Symptoms lasting at least 3 months
   • Absence of other conditions explaining sinus tachycardia 2

Diagnostic Tests

• Active standing test: Measures heart rate and blood pressure changes when moving from supine to standing position 1
• Head-up tilt table test: Alternative method to evaluate orthostatic changes 3
• Laboratory tests recommended by the American College of Cardiology:
  • Complete blood count (to rule out anemia)
  • Electrolytes and renal function
  • Serum tryptase (especially important due to association with mast cell activation syndrome)
  • ECG (to assess for QT interval abnormalities or arrhythmia patterns) 1

Specialist Involvement

While cardiologists typically lead the diagnostic process, POTS may involve multiple body systems, and a multidisciplinary approach may be beneficial:

• Cardiologists: Primary specialists for diagnosis and management 1, 4
• Autonomic neurologists: May be involved, especially in cases with prominent neurological symptoms
• Electrophysiologists: May assist in complex cases 4

Common Pitfalls in Diagnosis

1. Failure to recognize POTS in post-viral contexts: Up to 40% of POTS cases may follow viral infections, including COVID-19 1, 3

2. Overlooking associated conditions that commonly occur with POTS:

   • Mast cell activation syndrome (25.2% of MCAS patients have POTS)
   • Hypermobile Ehlers-Danlos syndrome
   • Autoimmune disorders
   • Chronic fatigue syndrome 1

3. Misattribution to psychological causes: POTS is a physiological disorder, though psychological factors may exacerbate symptoms 5

4. Incomplete testing: Failure to perform both supine and standing measurements or inadequate duration of standing measurements 1

Patient Demographics

POTS predominantly affects:

• Females (5:1 female-to-male ratio)
• Young adults (most commonly between ages 20-40)
• Adolescents, often within 1-3 years of growth spurts 6, 5

By recognizing the appropriate specialist for POTS diagnosis and understanding the diagnostic criteria, patients can receive proper evaluation and treatment for this often debilitating condition.