How is Dysautonomia / POTS diagnosed?

Diagnosing Dysautonomia / POTS

Dysautonomia refers to a group of conditions that affect the autonomic nervous system, which controls involuntary bodily functions. One specific type of dysautonomia is Postural Orthostatic Tachycardia Syndrome (POTS), characterized by an abnormal increase in heart rate upon standing up. Diagnosing dysautonomia, including POTS, involves a comprehensive evaluation of symptoms, medical history, and various diagnostic tests.

Medical History and Symptoms

The first step in diagnosing dysautonomia is a thorough medical history review. The healthcare provider will ask detailed questions about the patient's symptoms, such as dizziness, lightheadedness, rapid heartbeat, fatigue, and fainting episodes. They will also inquire about any underlying medical conditions, medications, and family history of similar symptoms.

Physical Examination

A physical examination is conducted to assess the patient's overall health and identify any signs of dysautonomia. The healthcare provider will check blood pressure and heart rate in different positions, including lying down, sitting, and standing. They may also examine the patient's reflexes, skin temperature, and perform a neurological evaluation.

Tilt Table Test

The tilt table test is a commonly used diagnostic tool for dysautonomia, including POTS. During this test, the patient lies flat on a table that can be tilted to different angles. The healthcare provider monitors the patient's heart rate, blood pressure, and symptoms while changing the table's position. This helps determine if there is an abnormal heart rate response to postural changes.

Autonomic Function Tests

Autonomic function tests evaluate the functioning of the autonomic nervous system. These tests measure various physiological responses, such as heart rate, blood pressure, sweating, and pupillary reflexes. Some commonly used autonomic function tests include:

• Heart Rate Variability (HRV) Analysis: This test assesses the variation in time intervals between heartbeats, providing insights into autonomic nervous system function.


• Sudomotor Testing: Sudomotor function is evaluated by measuring sweat production in response to different stimuli, helping assess autonomic nerve damage.


• Valsalva Maneuver: This test involves blowing into a tube against resistance while heart rate and blood pressure are monitored, assessing autonomic function.


• Quantitative Sudomotor Axon Reflex Test (QSART): QSART measures sweat production in response to electrical stimulation, aiding in the diagnosis of autonomic neuropathies.

Laboratory Tests

Laboratory tests may be ordered to rule out other potential causes of symptoms and to assess overall health. These tests can include:

• Blood Tests: Blood tests help evaluate thyroid function, blood sugar levels, electrolyte imbalances, and other factors that may contribute to dysautonomia symptoms.


• Urinalysis: Urine analysis can provide information about kidney function and detect any abnormalities.


• Autonomic Antibody Panel: In some cases, specific autoantibodies associated with dysautonomia may be tested to aid in diagnosis.

Additional Diagnostic Procedures

In certain cases, additional diagnostic procedures may be recommended to further evaluate dysautonomia symptoms. These can include:

• Echocardiogram: An echocardiogram uses ultrasound to assess the structure and function of the heart, helping identify any underlying cardiac abnormalities.


• Electrocardiogram (ECG or EKG): An ECG records the electrical activity of the heart, aiding in the detection of arrhythmias or other cardiac abnormalities.


• 24-Hour Holter Monitoring: This test involves wearing a portable ECG device for 24 hours to monitor heart rhythm and detect any irregularities.


• Electroencephalogram (EEG): An EEG measures brain wave activity and can help identify any neurological causes of dysautonomia symptoms.

Consultation with Specialists

Depending on the specific symptoms and suspected underlying causes, consultation with various specialists may be necessary. These can include cardiologists, neurologists, endocrinologists, and rheumatologists, among others. Collaboration between different specialists helps ensure a comprehensive evaluation and accurate diagnosis.

It is important to note that diagnosing dysautonomia, including POTS, can be complex and may require multiple tests and consultations. A thorough evaluation by healthcare professionals experienced in autonomic disorders is crucial for an accurate diagnosis and appropriate management.