Tools

Malmö POTS Symptom Score

MAPS: a 12-symptom score for POTS symptom burden, past 7 days

The Malmö POTS Symptom Score (MAPS) was developed at Lund University and published in the Journal of Internal Medicine in 2023. It is the first self-rating score designed specifically for POTS. You rate 12 common symptoms (five cardiac, seven non-cardiac) from 0 (no symptoms) to 10 (very pronounced) for the past 7 days. The total runs from 0 to 120.

In the validation study, patients with tilt-test-confirmed POTS averaged 78. Healthy controls averaged 14. A threshold of 42 or more separated the groups with 97% sensitivity and 98% specificity. Because it covers a single week, MAPS suits regular tracking: before and after starting a medication, an intervention, or a pacing change.

MAPS complements the other autonomic tools here: the COMPASS-31 covers autonomic symptoms more broadly across six domains, the Orthostatic Grading Scale grades your usual orthostatic pattern, the Vanderbilt Orthostatic Symptom Score is the trial measure rated while standing, and the NASA lean test gives you the objective heart-rate data that a POTS assessment actually requires. Together, a MAPS score and lean-test readings give an appointment something structured to work from.

This is not a diagnostic tool. POTS is diagnosed from a documented orthostatic heart rate response with symptoms, after excluding other causes. A symptom score alone cannot diagnose it. The original study compared tilt-confirmed POTS with healthy controls only, so scores may also be high in other conditions with similar symptoms, such as ME/CFS or long COVID, and a high score does not itself indicate POTS. Discuss your results with your doctor. Based on: Spahic JM, Hamrefors V, Johansson M, et al. Malmö POTS symptom score: Assessing symptom burden in postural orthostatic tachycardia syndrome. J Intern Med. 2023;293(1):91–99 (open access, CC BY-NC).

Rate each symptom for the past 7 days, where 0 = no symptoms and 10 = very pronounced symptoms.

Cardiac symptoms

Dizziness or light-headedness

Presyncope (feeling that you are about to faint)

Palpitations (rapid or pounding heartbeat)

Shortness of breath

Chest pain or chest discomfort

Non-cardiac symptoms

Headache

Concentration difficulties ("brain fog")

Muscle pain

Nausea

Gastrointestinal symptoms (stomach pain, diarrhoea, or constipation)

Fatigue

Insomnia (difficulty sleeping)

Understanding your MAPS score

What the score measures

MAPS is a 12-question self-rating score designed specifically for POTS, published by a team in Malmö, Sweden, in 2023. You rate five cardiac symptoms (such as palpitations and dizziness) and seven non-cardiac symptoms (such as fatigue, brain fog and nausea) from 0 (no symptoms) to 10 (very pronounced) for the past 7 days. The total runs from 0 to 120; higher means a heavier symptom burden.

The symptoms are those reported by at least 75% of 4,835 people in an international POTS survey (Spahic et al. 2023).

The COMPASS-31 was built for autonomic disorders in general. MAPS was built for POTS and asks only about the past 7 days, which suits regular tracking. Its authors cite earlier work suggesting the COMPASS-31 underweights some symptoms that matter in POTS.

Score bands

The only published cut-off is 42. In the original study, a total of 42 or more best separated 62 people with tilt-confirmed POTS from 50 healthy controls, with 97% sensitivity and 98% specificity. People with POTS averaged 78 and healthy controls 14. No mild, moderate or severe bands have been published.

Average MAPS totals in published studies
GroupPeopleAverageSource
Healthy controls (Sweden)5014 (SD 12)Spahic et al. 2023
POTS confirmed by tilt test (Sweden)6278 (SD 20)Spahic et al. 2023
POTS, specialist clinic (Germany)2763Stick et al. 2024

The POTS group was small and highly selected, from one specialist centre, and the authors say the score still needs testing elsewhere. Treat 42 as a guide, not a line.

What a change in score means

No minimal important change has been published, and the original study scored each person once, so it did not measure how much totals vary from week to week. The authors suggest MAPS for tracking symptoms and treatment response but say this still needs testing. A change that holds across several weekly results is more likely to be real than a one-off difference.

Rating weekly or fortnightly around a treatment change gives a usable trend, and your saved results above keep it on this device. The symptom diary can hold the day-to-day detail.

What it does not measure

No. MAPS measures symptoms, not heart rate. The study compared POTS only with healthy people, so it cannot tell POTS apart from other conditions with similar symptoms, such as ME/CFS, and it excluded people whose POTS followed COVID-19. POTS is diagnosed from a sustained heart rate rise on standing or tilt, with symptoms, once other causes have been ruled out.

For the heart rate side, use the NASA lean test and the 30 bpm threshold explainer.

Taking this to your GP or consultant

Bring your total, the date, your highest-rated symptoms and the trend from your saved results. Most GPs will not know MAPS: describe it as a 12-symptom POTS questionnaire from Lund University (J Intern Med 2023), where 42 or more separated POTS from healthy controls. It supports asking for a lying and standing heart rate and blood pressure check, alongside any lean test readings, but is not evidence of a diagnosis. See preparing for a GP appointment.

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