Testing

Do I have POTS?

How to check for POTS at home before seeing your GP: a step-by-step NASA lean test, POTS symptom questionnaires (MAPS, VOSS, OGS) and the COMPASS-31 for wider dysautonomia.

Postural orthostatic tachycardia syndrome (POTS) is defined by what your heart rate does when you stand up: a sustained rise of 30 beats per minute or more within 10 minutes (40 or more if you are aged 12 to 19), without a significant drop in blood pressure, alongside symptoms on standing for at least three months.

Only a clinician can diagnose it. But there are three things you can do at home to work out whether it is worth asking about, and to give your GP something concrete to look at.

1. Do a NASA lean test

The NASA lean test is a simple home version of a tilt table test. It gives you the heart rate data that a POTS assessment is based on.

What you need

  • A heart rate monitor: a pulse oximeter, smartwatch or chest strap
  • A blood pressure cuff (optional but very useful)

How to do it

  1. Avoid a large meal, caffeine and exercise for at least two hours beforehand. If you are prone to fainting, have someone nearby.
  2. Lie flat for 10 minutes and take your heart rate at 1, 3, 5 and 10 minutes.
  3. Stand up and lean your back against the wall with your heels 15–20 cm out from it, legs straight and arms loose.
  4. Stay there for 10 minutes, taking readings at 1, 3, 5 and 10 minutes.
  5. Stop straight away and sit or lie down if you feel faint or unwell.

Your result is the highest standing reading minus your last lying reading. A rise of 30 bpm or more with symptoms is a good reason to ask for a clinic stand test or an autonomic referral. It cannot confirm POTS on its own, and a normal result does not rule it out, so it is worth repeating on a few different days at the same time and with the same device.

Tool: the NASA lean test guide walks you through each stage with a timer and chimes, logs your readings and works out your heart rate change for you. To keep a record over several tests, use the stand test logger.

2. No equipment? Score your symptoms instead

If you do not have a heart rate monitor to hand, a symptom questionnaire is a good place to start. None of these can tell you whether you meet the heart rate criteria, but they put a number on how much being upright affects you, which helps you decide whether to pursue testing and gives your GP a clear summary.

  • Malmö POTS Symptom Score (MAPS): the first symptom score designed specifically for POTS. You rate 12 symptoms from the past week from 0 to 10, and the page explains the validated threshold of 42. Because it covers a week, it works well for weekly tracking.
  • Vanderbilt Orthostatic Symptom Score (VOSS): nine symptoms rated 0 to 10 while you are upright, as used in POTS drug and compression trials. It is a snapshot of how you feel right now, and if you later do a lean test, you can complete it in the final minute of standing.
  • Orthostatic Grading Scale (OGS): a five-question grading from the Mayo Clinic covering how often you get symptoms, how severe they are, what triggers them, how they affect daily activities and how long you can stand. It is scored 0 to 20, with mild, moderate and severe bands.

If your scores suggest orthostatic symptoms are a big part of your picture, the next step is a lying and standing heart rate check, either with a lean test or through your GP. If you are not sure which questionnaire suits you, see which questionnaire should I take?

3. Don’t meet the criteria but still have the symptoms? Try the COMPASS-31

POTS has a fixed heart rate cut-off, but plenty of people have the symptoms without crossing it. You might still have orthostatic intolerance or a wider problem with the autonomic nervous system (dysautonomia), which controls heart rate, blood pressure, sweating, digestion, the bladder and the pupils.

The COMPASS-31 is the standard questionnaire for this. Developed at the Mayo Clinic, it asks 31 questions across six areas: orthostatic intolerance, skin colour changes, sweating and dryness, digestion, bladder and eyes. You get a weighted score from 0 to 100, broken down by area.

There is no agreed cut-off, but the results page shows reference points from published studies so you can see where you sit. It is most useful for showing which systems are affected and for tracking change over months. Take your total and area scores to your GP to support a request for assessment.

Taking it to your GP

Whichever route you take, bring your results, the date and, for a lean test, the device you used and any heart rate medication you take. Present them as a reason to ask for proper testing rather than as a diagnosis. My guide to preparing for a GP appointment has more on how to get the most from that conversation.

Further reading