"You mainly suffer from anxiety."— what you've probably been told
POTS / dysautonomia
POTS is increasingly recognised, particularly post-COVID. NG188 covers autonomic symptoms in the post-COVID context; broader Royal College of Physicians guidance also exists. The letter cites the relevant authority for your situation.
The wait: Patients see an average of 7 doctors before diagnosis.
POTS is often missed because the standing test isn't performed. A 10-minute active stand or NASA Lean Test is straightforward and inexpensive but rarely offered without prompting.
- An active stand test or referral for tilt-table testing
- Referral to cardiology, autonomic services, or post-COVID clinic
- Consideration of POTS in the differential diagnosis
How is POTS diagnosed?
Sustained heart-rate increase of ≥30 bpm (≥40 in adolescents) within 10 minutes of standing, in the absence of orthostatic hypotension, with chronic symptoms. The letter requests the relevant test.
What's usually said in the room
"You mainly suffer from anxiety."
What the guideline actually says
POTS is often missed because the standing test isn't performed. A 10-minute active stand or NASA Lean Test is straightforward and inexpensive but rarely offered without prompting.
Source: COVID-19 rapid guideline: managing the long-term effects of COVID-19 (autonomic symptoms) (NG188)
Outcomes from people with POTS / dysautonomia
One short email each Sunday — anonymised stories from people who got their GP to take them seriously.