Reviewed on : 16 Jun 2026

Reviewed by : Geeta Paul

Expires : 16 Jun 2028

Postural Orthostatic Tachycardia Syndrome (POTS) clinic UHCW

Referral Criteria and Checklist for Referring Clinicians

This page provides 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 referral criteria:

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

• Symptoms of orthostatic intolerance (ie. 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)
• Age limit for 18 years and over (with exceptions for patients aged 16-18, considered only on exceptional circumstances)

Pre-Referral Investigations:

The following investigations and documents must accompany all referrals:

• Orthostatic vital signs (lying and standing, heart rate  & blood pressure at 5 minutes)
• 12 lead ECG (only when clinically indicated)
• Full blood count, electrolytes, renal profile & Thyroid function (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)
• Advice avoidance of prolonged standing, dehydration, and heat exposure

POTS Referral Checklist

Please ensure all boxes are ticked before referral:

☐ HR rise > 30 bpm (within 5 mins standing)

☐ No orthostatic hypotension

☐ symptoms for > 3 months

☐ secondary causes excluded

☐ orthostatic vitals documented

☐ symptoms summary provided