Postural Orthostatic Tachycardia Syndrome (POTS): A Frequently Missed Diagnosis

Published:November 28, 2022DOI:


      • The final common pathway of postural orthostatic tachycardia syndrome (POTS) is prolonged sympathetic compensatory response to decreased cardiac output upon standing.
      • The major diagnostic criteria for POTS include a sustained tachycardia upon standing, lack of orthostatic hypotension, symptoms of orthostatic intolerance for at least 6 months, and the elimination of other known causes of tachycardia.
      • Research has found that most POTS patients find improvements through a combination of nonpharmacologic and pharmacologic interventions that combat hemodynamic instability and regulate autonomic imbalance.
      • Common triggers include surgery, concussion, traumatic event, pregnancy, or viral illness.


      Postural orthostatic tachycardia syndrome (POTS) is a debilitating chronic illness that involves a sustained tachycardia upon standing and causes multisystem symptoms. Although POTS affects millions, in 2019, more than two-thirds of providers had never heard of POTS. Most POTS patients (83%) have reported being misdiagnosed with a psychological condition, and some wait decades for a proper diagnosis or treatment. Understanding the relationship between autonomic compensation and hemodynamic stability can help a provider recognize and manage POTS. The purpose of this report is to provide nurse practitioners with a practical guide to recognizing, diagnosing, managing, and educating patients with POTS.


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      Aubrey R. George, MSN, RN, is a recent graduate of Brigham Young University's Master of Science in Nursing Program, Provo, UT, and can be contacted at [email protected]


      Blaine Winters, DNP, ACNP-BC is a professor of nursing at Brigham Young University, Provo, UT.