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Fainting and POTS Assessment
A fainting and POTS assessment looks at what your heart rate and blood pressure do when you have symptoms. The aim is to tell apart a drop in blood pressure, a heart rhythm problem and symptoms brought on by standing.
Fainting, or syncope, is a brief loss of consciousness caused by a temporary drop in blood flow to the brain. Feeling close to fainting without losing consciousness is called presyncope.
When you stand up, gravity draws blood towards your legs and abdomen. Your blood vessels tighten and your heart rate adjusts to keep blood flowing to the brain. If this response isn't working properly, you may feel lightheaded or sick, or notice a racing or pounding heartbeat (palpitations). Symptoms that happen when you stand and ease when you lie down are called orthostatic intolerance.
Postural orthostatic tachycardia syndrome (POTS) is one cause of these symptoms. Doctors diagnose it from recurring symptoms and measurements taken after standing. A single heart rate or blood pressure reading isn't enough.
Call triple zero (000) for severe, worsening or persistent chest pain, or chest discomfort with breathlessness, sweating, nausea or pain spreading to your arm, jaw or back.
Do not wait for a routine appointment or drive yourself to hospital.
These conditions can feel similar, but they affect blood pressure and heart rate differently.
Pain, heat, standing for a long time, seeing blood, coughing or straining can trigger a reflex that lowers blood pressure and sometimes slows the heart. You may feel sick or sweaty, look pale or notice your vision fading before you faint.
Orthostatic hypotension is a fall in blood pressure when you stand. It can cause dizziness, blurred vision or fainting. Medicines and dehydration are possible causes, as are problems with the nerves that regulate blood pressure. Comparing readings taken lying down and standing helps detect it; a seated reading can miss it.
With POTS, heart rate rises more than expected and stays raised when you stand, without the large blood pressure drop of orthostatic hypotension. Symptoms ease when you lie down. You don't have to faint to have POTS. It can also cause fatigue, sleep problems, headaches and digestive symptoms. Your doctor will ask how long symptoms have lasted and check for other causes.
A heart rhythm that's too fast or too slow can reduce blood flow enough to cause a faint. This may happen without warning or with palpitations. In POTS, the heart usually keeps its normal rhythm but beats faster on standing.
Start with what you were doing when you felt unwell. Had you just stood up or been standing for a while? Describe any warning signs, such as nausea or blurred vision, and whether lying down helped.
If you fainted, tell the doctor how long you were unconscious and how you felt afterwards. An account from someone who saw it can help. Mention recent illness or medicine changes, any heart condition, and any relative who died suddenly from a heart problem.
Get urgent medical help if you faint during exercise, while sitting or lying down, without warning, or with chest pain, palpitations or an injury. Ongoing confusion, a severe headache or new trouble speaking also needs urgent care. Don't assume these symptoms are due to POTS.
Treatment aims to reduce episodes and make daily activities more manageable. The plan depends on what brings symptoms on, whether you lose consciousness and how much standing or activity you can tolerate.
For reflex fainting, learning your warning signs and triggers can help. Lie down safely if you feel a faint coming on. Avoid driving or operating machinery after a faint until you've spoken with a doctor. Your doctor will also check whether a medicine is lowering your blood pressure.
For POTS, compression garments can reduce blood pooling in the legs and abdomen when you stand. Medicines may slow the heart rate, support blood pressure or increase blood volume. Extra salt or fluid may help some people, but it can be unsuitable with other health conditions, so the advice has to suit your health. Follow-up looks at symptoms and daily function as well as the numbers.
If activity makes you feel worse later, tell your doctor. This can happen with long COVID. Pacing means balancing activity and rest to help avoid worsening symptoms. Fatigue, digestive problems and difficulty concentrating may need treatment of their own.
Your doctor compares your account of an episode with an examination and heart recordings. For symptoms on standing, heart rate and blood pressure are measured while you're lying down and repeatedly after you stand. This shows whether blood pressure falls, whether heart rate stays unusually high and how those changes relate to what you feel. A brief rise just after standing is different from the sustained change seen in POTS. Blood tests can check for anaemia or an overactive thyroid, which can cause similar symptoms. A separate provider does the blood tests.
An ECG records the heart's electrical activity. A Holter monitor records heart rhythm as you go about daily life, so your doctor can see what happens during symptoms. The recording length depends on how often episodes occur. A Holter recording can't diagnose POTS on its own. An echocardiogram is an ultrasound that looks for problems with the heart's structure.
If symptoms on standing remain unexplained, your doctor may refer you for tilt-table testing at a specialist or hospital service. The table tilts towards standing while heart rate and blood pressure are measured. A normal result doesn't rule out every cause of symptoms.
You'll need a valid referral from your GP or specialist for a cardiologist consultation. Your symptoms and examination will help the cardiologist decide whether you need tests. Your GP will receive a report explaining what was found and the next steps.
Consultations are privately billed. If you're eligible, Medicare pays part of the consultation fee when you have a valid referral from your GP or specialist. The clinic will confirm the amount left to pay before the visit.
Heartscope cardiologists see patients at clinics in Melbourne and Queensland. If you have a referral, our team can confirm the location and appointment details.
View clinic locationsYes. A GP or specialist can refer you to a Heartscope cardiologist for fainting, symptoms on standing or suspected POTS. Tilt-table testing may need referral to another service. Any hospital procedures take place elsewhere.
Yes. POTS can begin after a viral illness, including COVID-19. Mention when symptoms started, although the timing alone doesn't confirm the cause.
A normal ECG is one part of the assessment. It records a short period of heart activity, so a rhythm that comes and goes may not show on it, and it doesn't measure the full response to standing.
Call triple zero (000). If the person isn't breathing normally, start CPR and follow the emergency operator's instructions. After an unexplained faint, the person should see a doctor once they've recovered.
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