Plate Nº 48 · recorded October 9, 2026
Health & Medicine ResearchReported finding
Patients Wait Nearly Six Years for POTS Diagnosis, Experts Warn
Cardiologists say standard heart tests miss POTS because they are done lying down. A simple 10-minute stand test at the first visit could speed diagnosis for patients waiting nearly six years.
By Nathan Brooks4 min read763 words
In brief
- Patients wait an average of nearly six years for a POTS diagnosis.
- A heart rate rise of at least 30 beats per minute upon standing, without a blood pressure drop, supports diagnosis.
- POTS affects about five women for every man; roughly 40% of cases follow a viral illness.
- The perspective, led by Dr. Marat Fudim of Duke University, appeared in the Journal of the American College of Cardiology.
- Gravity shifts about 0.5 liters of blood to the legs and belly on standing; in POTS the compensating system fails.
Patients with postural orthostatic tachycardia syndrome, or POTS, wait an average of nearly six years for a diagnosis — and an international group of cardiologists says medicine has been looking for the condition in exactly the wrong place.
In a perspective published in the Journal of the American College of Cardiology, titled "Managing POTS: A Cardiovascular Call to Action," the experts urge cardiologists to change how they recognize, diagnose and treat the condition. Dr. Blair Grubb, distinguished university professor of medicine and pediatrics and director of the Cardiac Electrophysiology and Autonomic Disorders programs at The University of Toledo, is among the authors.
Dr. Marat Fudim of Duke University led the paper. Co-authors include Dr. Satish Raj of the University of Calgary, Dr. Artur Fedorowski of the Karolinska Institutet, Dr. Stavros Stavrakis of the University of Oklahoma and Elisabetta Burchi of Rome.
What is POTS and why does standing trigger it?
POTS is a disorder in which the body struggles to regulate blood flow and heart rate when a person stands up. For those living with it, simply rising to their feet can trigger a racing heart, lightheadedness, brain fog, shakiness and exhaustion. Symptoms often improve when the person lies down.
The mechanism involves the autonomic nervous system — the body's automatic control system. Grubb explains it plainly.
"When any of us stands up, gravity pulls about a pint (0.5 liters) of blood down into our legs and belly, and the autonomic nervous system instantly tightens the blood vessels to push that blood back up to the heart and brain," Grubb said. "In POTS, that system doesn't work properly."
As blood pools in the lower body, the heart compensates by beating significantly faster. Yet many standard cardiac tests still come back normal.
Why do conventional tests miss it?
The answer, according to Grubb, is body position. Most cardiac tests place the patient lying down or sitting still — and POTS only reveals itself when a person is upright.
"We've been looking for it in the one body position where it hides," Grubb said.
The disconnect frustrates patients, who can feel severely unwell while their test results look unremarkable. That mismatch also contributes to the long diagnostic delay, the authors suggest.
What does the 'active stand test' involve?
The authors recommend that cardiologists perform an active stand test at the patient's first visit whenever symptoms suggest orthostatic intolerance — trouble tolerating standing — rather than sending the patient to a specialty clinic first. The test is simple:
- The patient rests lying down for 5 to 10 minutes.
- The patient then stands while clinicians monitor heart rate, blood pressure and symptoms for up to 10 minutes.
- A sustained heart rate increase of at least 30 beats per minute in adults, without a corresponding drop in blood pressure, supports a POTS diagnosis.
Doing this early in the diagnostic process, the authors argue, could catch a condition that conventional workups routinely miss.
Should treatment target more than heart rate?
The paper also pushes back on the idea that lowering a patient's heart rate is the goal of therapy. Grubb frames the racing heart as a warning sign rather than the disease itself.
"The fast heart rate is the signal, not the illness," Grubb said. "We can bring a patient's heart rate down to normal and still have a young person who can't get through a shower or a school day."
Instead, physicians and researchers should ask whether treatment lets patients stand longer, return to school or work, think clearly and tolerate physical activity.
Who gets POTS?
According to the paper, POTS affects about five women for every man, and roughly 40% of cases begin after a viral illness. The authors stress that more research is needed to understand the condition and to develop treatments aimed at its underlying causes, not just its symptoms.
Grubb, who has treated POTS patients for most of his career, has watched the condition move from being dismissed to being recognized. He believes better recognition would transform the patient experience.
"The biggest change would be that patients would be believed," Grubb said. "For many, this would be the first time medicine took them seriously."
"This paper is a call for the next step," he added.
The findings reflect the authors' expert perspective rather than a new clinical trial, and the recommendations will need broader uptake and study before they change standard practice. Still, for a patient community that has spent an average of six years searching for answers, the call to action signals that cardiology is finally taking POTS seriously.
via Medical Xpress (Source)
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