Postural Orthostatic Tachycardia Syndrome
A form of autonomic dysfunction that rarely travels alone — and is typically seen in fragments rather than as the coherent, multi-system picture it usually is.
What we mean when we say POTS.
POTS is defined by a sustained increase in heart rate on standing, without a corresponding drop in blood pressure, accompanied by a constellation of symptoms including fatigue, brain fog, exercise intolerance, and GI and neurologic findings.
In most cases, POTS is better understood as one expression of broader dysautonomia, frequently co-occurring with hypermobility disorders (including hEDS), mast cell activation syndrome, and small fiber neuropathy.
Care is fragmented: cardiology handles the tachycardia, neurology the dysautonomia, rheumatology the joint findings, allergy the mast cell features — without anyone synthesizing the picture.
The pattern we see in POTS cases.
- 01Standard autonomic workup varies widely by center, and many patients have incomplete or inconsistent testing across specialists.
- 02POTS is frequently treated in isolation, when the underlying driver — hypermobility, autoimmunity, mast cell activity, post-viral inflammation — is often more actionable than the tachycardia itself.
- 03Treatment response is highly individual. What works for one POTS subtype may be unhelpful or counterproductive for another, and subtyping is rarely done in non-specialist settings.
- 04Long COVID has dramatically expanded the POTS population and the evidence base is evolving rapidly, making up-to-date synthesis difficult without dedicated attention.
The Ternary Signal Library for POTS.
Our Signal Library codifies the specific patterns that matter in POTS — labs, genetic variants, imaging findings, symptom clusters, and comorbidity combinations. Your case is mapped against these signals in Stage 4 of the workflow; each activated signal is weighted and prioritized for your presentation.
- —Tilt-table test results
- —10-minute stand test — HR delta, BP stability
- —Valsalva ratio
- —Heart rate variability (HRV) patterns
- —24-hour Holter monitor findings
- —Plasma norepinephrine (supine and standing)
- —Plasma renin activity, aldosterone
- —Beta-receptor antibody testing (where available)
- —Small fiber neuropathy workup — skin biopsy, QSART
- —Post-viral / post-COVID history
- —hEDS features — Beighton, 2017 criteria
- —MCAS — symptom pattern + biomarkers
- —GI dysmotility — gastroparesis workup
- —Autoimmune markers
- —Endocrine context — thyroid, cortisol
- —Lifestyle measures — salt, fluids, compression, exercise
- —Medication trials — fludrocortisone, midodrine, ivabradine, beta-blockers
- —Low-dose naltrexone
- —Response patterns per intervention
The Ternary Health approach to POTS.
Review autonomic testing, cardiology findings, and symptom patterns to place the case in a subtype framework the current literature supports.
Integrate co-occurring features — hypermobility, mast-cell, neurologic, GI, post-viral — into a single view rather than a stack of separate problems.
Map treatment options against the subtype and the evidence, from lifestyle and compression through pharmacologic strategies, and identify the clinicians most likely to advance each branch.
Build an action plan that sequences investigations and interventions so progress can be measured, rather than adding interventions in parallel with unclear attribution.
How a POTS case moves through our workflow.
Our nine-stage workflow is the same for every engagement. What changes per condition is the content at each stage — the records we pull, the signals we apply, the specialists we map, the pathways we evaluate. Below, how your case specifically would move through each stage.
What you receive.
- —A written case synthesis with subtype assessment
- —Integrated view of co-occurring conditions
- —Treatment-option map with evidence ratings
- —Specialist identification and visit-prep materials
- —A written action plan and follow-up support as you implement it
What prospective POTS clients ask most.
Ready for a case review?
Applications are reviewed within three business days.