How POTS Is Diagnosed: Criteria, Stand Test and Tilt Table

No blood test or scan confirms POTS. Doctors diagnose it from symptoms plus a measured heart rate response to standing, after ruling out other causes.

The criteria

The Heart Rhythm Society (2015), the Canadian Cardiovascular Society (2020) and a 2019 NIH consensus agree on five parts.

The CMAJ 2022 review adds that the rise should appear on at least two readings during the stand (for example at 1, 3, 5, 8 and 10 minutes), after 5 to 10 minutes lying flat.

How clinicians measure it

• Active stand test. You lie down, then stand while a clinician records heart rate and blood pressure. No special equipment.
• Head-up tilt table. A table tilts you to about 60 to 70 degrees, removing muscle effort. It helps when a stand test is unclear or fainting is the main concern.
• NASA Lean Test. A 10-minute wall-lean stand. See the NASA Lean Test guide.

The authors of the 2025 study urge caution with short stands in young people. A 10-minute protocol read by a clinician gives a more reliable result.

Where home numbers fit

Home readings give your doctor data from several days and show whether symptoms line up with heart rate. Two cautions apply. A large Apple Watch meta-analysis found limits of agreement of roughly 11 bpm either way, mostly measured during activity, and that margin matters at a 30 bpm line.

Home tests also skip blood pressure unless you use a cuff, and blood pressure separates POTS from orthostatic hypotension. See why blood pressure matters.

The threshold debate

A 2026 international consensus argues that many people with real orthostatic intolerance fall short of 30 or 40 bpm and still deserve a workup and treatment. It has not changed the formal criteria. If your rise sits just under the line and your symptoms are significant, say so at your visit.

What to do with this

Check your numbers, print the visit checklist, and take both to a doctor who can examine you.