Basic calculations
Postural tachycardia: pulse on standing (POTS)
Interprets the active stand test. A sustained heart-rate rise of at least 30 bpm (40 bpm at age 12–19) within 10 minutes of standing, without orthostatic hypotension, is orthostatic tachycardia; with orthostatic symptoms for at least 3 months and no other cause it meets the criteria for postural orthostatic tachycardia syndrome (POTS). A rise with a BP fall is flagged as orthostatic hypotension, and a high supine rate as possible inappropriate sinus tachycardia. Lists the causes to exclude and the HRS 2015 treatment classes.
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How to measure
Active stand test (or head-up tilt)
- Lie the patient flat for at least 5 minutes; record HR and BP.
- Stand up; record HR and BP at 1, 3, 5 and 10 minutes.
- Enter the supine values and the highest standing HR with the BP at that time.
Supine (after 5 min)
Standing (within 10 min)
Highest sustained heart rate
Clinical criteria for POTS
Postural pulse
Enter the supine and standing heart rate.
References
- Freeman R, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 2011;21:69-72.
- Sheldon RS, et al. 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm 2015;12:e41-e63.
- Vernino S, et al. Postural orthostatic tachycardia syndrome (POTS): state of the science and clinical care from a 2019 National Institutes of Health expert consensus meeting. Auton Neurosci 2021;235:102828.
- Brignole M, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018;39:1883-1948.
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