You’re lightheaded when you stand. Your heart races after minimal activity. You can’t focus. You’re exhausted — but no one seems to know why.

For many patients, especially young women, symptoms like these are often dismissed or misdiagnosed as anxiety or stress. But in many cases, they point to a real and serious medical condition: POTS, or Postural Orthostatic Tachycardia Syndrome, and other forms of dysautonomia.

The diagnostic process can be confusing, frustrating, and prolonged. This guide breaks it down clearly: how POTS and dysautonomia are diagnosed, what tests are used, what doctors look for, and why seeing a POTS specialist in Maryland can make a big difference.

What Is Dysautonomia?

Dysautonomia refers to a group of disorders affecting the autonomic nervous system (ANS) — the part of your body that regulates automatic functions like heart rate, blood pressure, temperature control, digestion, and even pupil dilation.

When the ANS isn’t working properly, it can cause a wide range of symptoms, including:

• Rapid heartbeat
• Dizziness or fainting
• Digestive issues
• Temperature dysregulation
• Fatigue and brain fog
• Sleep disturbances

There are different types of dysautonomia, and POTS is one of the most common, especially in adolescents and adults under 50.

What Is POTS?

Postural Orthostatic Tachycardia Syndrome (POTS) is a specific type of dysautonomia that involves an abnormal increase in heart rate when a person transitions from lying down to standing up.

The diagnostic criteria are:

• An increase in heart rate of 30 beats per minute (bpm) or more within 10 minutes of standing (or 40 bpm in teens)
• No significant drop in blood pressure
• Symptoms must be chronic (lasting more than 6 months) and not better explained by another condition

POTS affects an estimated 1 to 3 million Americans, but it often goes undiagnosed or misdiagnosed due to overlapping symptoms with other conditions like chronic fatigue syndrome, anxiety, fibromyalgia, and long COVID.

Why Is POTS So Hard to Diagnose?

There are three major challenges:

1. Non-specific symptoms: Fatigue, brain fog, dizziness — these are common in many other conditions.
2. Lack of awareness: Many providers are not familiar with how to recognize or test for POTS.
3. Normal-looking basic tests: Routine lab work and vital signs at rest may appear normal, leading to dismissal of symptoms.

That’s why a targeted evaluation with the right testing — often performed by a POTS doctor in Maryland or an autonomic specialist — is so essential.

Step-by-Step: How Doctors Diagnose POTS or Dysautonomia

1. Medical History and Symptom Review

Every proper diagnosis begins with listening. A detailed patient history helps guide testing and rule out other causes.

Expect questions like:

• When did your symptoms begin?
• What triggers or worsens them?
• Do you feel better lying down?
• Have you fainted or nearly fainted?
• Do you feel heart palpitations or pounding when standing?
• Any history of viral infection, pregnancy, trauma, or surgery?

Providers will also ask about overlapping conditions such as:

• Ehlers-Danlos Syndrome (EDS)
• Autoimmune disorders
• Long COVID
• Mast Cell Activation Syndrome (MCAS)

2. Orthostatic Vital Signs

Simple but telling: your heart rate and blood pressure are measured:

• Lying down (after resting 5–10 minutes)
• Immediately after standing
• At 1, 3, 5, and 10-minute intervals while standing

A sustained rise in heart rate of 30 bpm (or 40 bpm for teens) supports a POTS diagnosis, especially if accompanied by symptoms.

3. Active Stand Test or NASA Lean Test

This is a more controlled version of orthostatic vitals, often used in POTS clinics. Patients are asked to lie quietly, then stand (or lean against a wall) for 10 minutes while heart rate and symptoms are monitored.

This can often be performed in the office without expensive equipment.

4. Tilt Table Test

The gold standard for diagnosing postural orthostatic tachycardic syndrome MD, the tilt table test involves:

• Lying on a motorized table that tilts you from horizontal to vertical
• Continuous monitoring of heart rate, blood pressure, and symptoms
• Test duration typically ranges from 10–45 minutes

Why it matters:

• It isolates the postural component of symptoms
• It helps distinguish POTS from other forms of dysautonomia like neurocardiogenic syncope or orthostatic hypotension

It’s important that a POTS specialist MD interprets the results, as some false positives or negatives can occur without proper context.

5. Holter Monitor or ECG

Some patients may be asked to wear a 24-hour Holter monitor or undergo an electrocardiogram (ECG) to evaluate:

• Heart rate variability
• Potential arrhythmias
• Episodes of tachycardia or bradycardia

This helps rule out cardiac causes of symptoms and may catch abnormalities that a brief in-office test would miss.

6. Blood and Lab Work

To rule out mimicking conditions, doctors may run:

• Thyroid panel
• Vitamin B12, D, iron, ferritin
• Cortisol levels
• Autoimmune markers (ANA, ESR, CRP)
• Plasma norepinephrine levels (sometimes upright vs. supine)

These labs don’t diagnose POTS directly, but they’re critical for excluding other disorders and identifying coexisting issues.

7. Autonomic Function Testing (if available)

In specialized centers or POTS clinics MD, patients may undergo:

• QSART (Quantitative Sudomotor Axon Reflex Test)
• Valsalva maneuver
• Deep breathing tests

These assess broader autonomic nervous system function and help determine if the patient has pure POTS or another form of dysautonomia.

Who Should You See for a Diagnosis?

Diagnosing POTS or dysautonomia requires a high degree of clinical awareness. Many primary care providers are unfamiliar with the condition or lack the tools to evaluate it thoroughly.

Depending on your symptoms, you may be referred to:

• A cardiologist
• A neurologist
• A physical medicine and rehabilitation (PM&R) physician
• A dedicated POTS doctor accepting new patients MD

At Diekman Dysautonomia, we specialize in complex cases involving POTS, long COVID, and coexisting autonomic disorders. Our Maryland clinic offers personalized testing, diagnosis, and follow-up care for patients seeking clarity and support.

What Happens After Diagnosis?

Diagnosis is the first (and often hardest) step. Once confirmed, treatment for POTS focuses on symptom management and lifestyle adaptation.

While each plan is individualized, treatment may include:

• Increased hydration and salt intake
• Compression garments
• Exercise programs (recumbent or seated to start)
• Medications like beta blockers, midodrine, or fludrocortisone

Finding the right regimen can take time, which is why working with a POTS specialist in Maryland or your region is so critical.

Final Thoughts

If you’re living with unexplained fatigue, dizziness, rapid heartbeat, or brain fog, don’t settle for vague answers or dismissals. POTS and dysautonomia are real, diagnosable conditions — and with the right care, they’re manageable.

Early diagnosis leads to better outcomes, improved quality of life, and often, a sense of validation after years of uncertainty.

Need Help Getting Diagnosed?

At Diekman Dysautonomia, we combine cutting-edge diagnostics with lived experience and deep empathy. We’re currently accepting new patients in Maryland and provide telehealth support for those who qualify.