Clinician handoff
POTS
Designed for a 60-second scan in primary care. Use this to explain why this theory fits, what would weaken it, and which tests are most worth discussing.
Why this still fits
My brain fog is dramatically worse when I am upright and better when I lie down. I want to discuss orthostatic testing and whether this fits POTS better than anxiety or another explanation.
What would weaken it
- -No positional worsening at all.
- -No heart-rate change, dizziness, or upright intolerance alongside the fog.
- -A stronger fit with anxiety, sleep apnea, or another non-positional cause.
Key points to communicate
- •I want orthostatic vitals or tilt-style evaluation rather than being told it's probably stress.
- •If this isn't POTS, I want to know what explains the clear upright-versus-flat change.
- •If it's POTS, I want guidance on fluids, salt, compression, and what needs formal testing first.
Bring this to the visit
- •Heart rate and blood pressure log: lying, sitting, and standing readings.
- •NASA lean test results if you have done one at home (10 minutes standing against a wall).
- •Fluid and salt intake estimate (target: 2-3L fluids, 3-10g sodium for POTS).
- •Medication list including beta blockers, midodrine, fludrocortisone, ivabradine.
Useful screening structure
- -Active standing test or NASA lean test (10 min) with HR and BP monitoring.
- -Tilt table test for formal diagnosis if office vitals are inconclusive.
- -Autoimmune markers (ganglionic AChR antibodies) if autoimmune POTS is suspected.
Tests and measurements to discuss
Tilt Table Test
What this helps clarify: Gold standard for POTS and orthostatic intolerance
Range context
HR rise <30 bpm
How to use the result
Save the result with date and symptoms from the same week.
Standing catecholamines
Autoimmune panel (ganglionic AChR)
A1c + fasting glucose context review
What this helps clarify: This route is for the situation where HbA1c and fasting glucose do not fully explain a strong post-meal or fasting crash pattern.
Range context
Interpret with timing pattern
How to use the result
If the averages are normal but the crashes are repeatable, ask what test would better capture variability.
Autonomic Testing
Questions to ask directly
- •Is my fog from reduced cerebral blood flow when upright, and how do we confirm this?
- •Should I be tested for autoimmune POTS, especially if this started after a viral illness?
- •What's the evidence for salt loading, compression, and volume expansion for cognitive symptoms?
- •If IV saline clears my fog, does that confirm hypovolemia and guide treatment?
Functional impact snapshot
- -Rate fog severity lying down vs sitting vs standing for 5+ minutes.
- -Track whether salt, fluid, and compression garment use changes cognitive function.
- -Note whether exercise reconditioning (recumbent, then upright) improves the baseline over weeks.
Escalate instead of self-managing if
- •Syncope with head injury or unsafe falls.
- •Severe hypertension during episodes suggesting hyperadrenergic POTS crisis.
- •Progressive autonomic failure rather than the typical POTS pattern.
Peer-reviewed references