Reviewed on : 13 Jan 2026

Reviewed by : Geeta Paul

Expires : 13 Jan 2028

Purpose:

To provide guidance for clinicians referring patients to the postural orthostatic tachycardia syndrome  (POTS) clinic.

It outlines strict referral criteria to ensure appropriate assessment of patients with suspected POTS and to streamline clinic triage.

Strict Diagnostic Criteria:

Patient’s must meet ALL of the following criteria for review:

• Symptoms of orthostatic intolerance (i.e. light-headedness, palpitations, fatigue, brain fog for at least 3 months)
• Sustained persistent heart rate increase of > 30 bpm (<40 bpm if aged 12-19) within 10 minutes of standing (provide at least 5 mins on active stand)
• No significant orthostatic hypotension (systolic BP drop >20 mmHg or diastolic BP drop >10 mmHg).
• Absence of other causes of sinus tachycardia (e.g. dehydration, anaemia, thyrotoxicosis, medication effects, structural heart disease).

Required Pre-Referral Investigations:

The following investigations and documents must accompany all referrals:

• Orthostatic vital signs (supine and standing HR & BP at 1,3, 5 (and 10 minutes if possible)
• 12 lead ECG
• Full blood count, electrolytes, renal profile & TSH
• Medication list, highlighting agents affecting heart rate or blood pressure.
• Brief symptom summary including duration, frequency and functional impact

(Referral from other tertiary hospitals please provide relevant clinic letters confirming diagnosis including tilt test reports attached to the referral)

Suggested Pre-Referral Management

• Encouraged adequate hydration 2-3L daily – front load in the beginning of the morning
• Increase dietary salt intake ( 10 g daily)
• Recommend gradual physical reconditioning (recumbent to upright progression)
• Consider compression garments (waist high or abdominal binders)
• Advise avoidance of prolonged standing, dehydration, and heat exposure

POTS Referral Checklist

Please ensure all criteria listed are present before referral:

• HR rise > 30 bpm (within 10 mins upright)
• No orthostatic hypotension
• Symptoms for > 3 months
• Secondary causes excluded (i.e. blood tests & ECG)
• Orthostatic vitals documented
• Symptoms summary provided