Tilt table tests (TTT) are uncomfortable, expensive, and time-consuming. It is agreed that TTT should be the standard for POTS diagnosis, but wouldn’t it be great if we had a way to look for POTS without going through the entire test? Well, we can. The poor man’s tilt table test as it is called is a check at your heart rate and blood pressure throughout laying, sitting, and standing.
The poor man’s tilt table test is not as reliable and should not be used by laypeople for diagnosis. However, it is a helpful tool to see if you should see a doctor about an official TTT or see a POTS specialist.
If you do not have a blood pressure cuff you can still record your pulse as that is helpful to know as well.
Materials
Heart Rate Monitor (can be on your smartphone)
Blood Pressure Cuff
Another Person
Steps
1. Find a clear space where you can lay, sit, and stand comfortably.
2. Lay down. You may have to lay for up to 10 minutes for your pulse to slow before measuring.
3. Check your heart rate and record. Repeat.
4. Check blood pressure and record. Repeat.
5. Sit up and wait a couple minutes
6. Check pulse and record
7. Check blood pressure and record. Repeat.
8. Stand
9. Check pulse and record (check multiple times over the time you can safely stand). Repeat.
10. Check blood pressure and record. Repeat.
Position
Heart Rate
Blood Pressure
Symptoms & Notes
Laying 1
Laying 2
Sitting 1
Sitting 2
Standing 1
Standing 2
Shortcomings
Doing a formal TTT means that you have medical professionals around to help if something goes wrong. Doing this version means that you may faint and hurt yourself. If you are worried have someone to help keep you safe or wait for an official TTT.
TTT tilt you slowly in a way in which your leg muscles are not engaged. Leg manoeuvres can help with POTS symptoms and standing by yourself means that you may use these manoeuvres and skew the results. If you have POTS symptoms you may have adopted this technique without even realising.
There are a lot of common misconceptions about POTS. There are ones I get from doctors, nurses, family, friends, and even other POTS patients. Remember that most of our POTS symptoms are different and that the same thing doesn’t work for everyone!
1. POTS Is NOT Anxiety
I don’t care how much POTS looks like anxiety- it isn’t. The increased heart rate, palpitations, and shortness of breath in POTS are caused by the autonomic nervous system. Medicines for anxiety and medicines for POTS do not work the same and do not necessarily alleviate POTS symptoms.
Anxiety can happen as a result of POTS or alongside POTS but I cannot stress enough that they are not the same thing. Strange scary symptoms can make patients nervous and the life change of living with a chronic illness is enough to make anyone anxious, but the underlying condition is not caused by anxiety.
2. POTS Symptoms Disappear When You Lay Down
I have had multiple doctors ask why I don’t just lay down to fix my symptoms. Let’s get this straight- POTS symptoms are exacerbated by standing but do not disappear when I lay down.
Many people with POTS feel terrible laying down as well. Unfortunately, POTS symptoms can reach you at any angle. Just last week my tachycardia was 130 bpm while laying down and relaxing for four hours. The chest pain and brain fog did not go away the entire time. So while standing makes things worse, lying is not a magic cure-all for our symptoms.
I have talked to very few people who feel 100% better once horizontal but it is not the average POTS patient.
3. Exercise Will Cure POTS
Some people with POTS have had this experience and I am thrilled for them. However, for many of us exercise is not a cure-all. I hear on support groups POTS patients who have been helped with exercise be judgemental and condescending towards those who have not been helped. Additionally, friends and family can claim you aren’t trying hard enough if exercise does not cure you. Please stop people!
Exercise helps POTS but for people like me it is not a cure. I have tried swimming, biking, rowing, and walking daily for months at a time. Exercise helped my symptoms but my POTS is still severe and unrelenting.
Just because you are able to exercise does not mean you get to judge people who can’t (or are not having the same results. Associated conditions that happen together with POTS such as Ehler’s Danlos and neuropathy can make exercise extremely painful and difficult.
Trying to work out with EDS is a lot like this.
4. Most People Grows Out Of POTS
I was diagnosed with POTS at 18 and being between a teen and adult made things complicated. Pediatricians claim that many people who get POTS in their teens outgrow POTS; that doesn’t happen as often in adults.
Every doctor I saw that first year after my diagnosis told me I would grow out of POTS. It is 7 years later and my POTS is worse than ever. I understand doctors wanting to give their patients hope but that hope kept me from coping with a major life change. Instead of coming to terms with having a chronic illness I only thought of POTS as temporary.
This negative experience is not unique to me. A lot of people who are diagnosed with POTS in their teens will never grow out of it. A lot of this has to do with associated conditions; for example, people with Ehler’s Danlos rarely grow out of POTS. Telling all teens POTS is temporary, when many cases are not, is not helping them cope with their illness.
5. POTS Is No Big Deal
POTS can be an annoyance or it can be severely debilitating. This variance is part of why POTS is so hard to understand. Often people who have heard of POTS have a friend mildly affected and cannot understand more severe cases.
“Claire never cancelled this much on me and she has POTS too. You obviously are just making excuses again.”
Don’t be confused by people with less severe cases; POTS is often far more than an inconvenience. Experts are clear. POTS can be serious and hugely lower patient’s quality of life.
Somehow being too sick to go out makes me a flake and is grounds to yell at me. I did not choose this.
Comparisons in the diminished quality of life in POTS have been described as equal to congestive heart failure, chronic obstructive pulmonary disease, and end stage kidney failure patients on dialysis. Some people with POTS are absolutely bedridden and unable to care for themselves. About two-thirds of POTS patients cannot work full-time and 98% of POTS patients cannot socialize as much as they would like.
POTS can be a big deal.
6. POTS Has Nothing To Do With Pain
POTS is not commonly associated with pain, but often causes a lot of patients pain. Chest pain is exceptionally common with POTS and is sometimes severe (I have had POTS chest pain hurt as much as a pulmonary embolism). POTS is also associated with migraines, neuropathic pain, and joint pain.
Many conditions associated with POTS cause pain as well. Ehler’s Danlos causes an extraordinary amount of pain and autoimmune conditions may cause pain as well.
7. Lifestyle Changes Can Cure Everyone
There are some naive people who believe that no POTS is so severe that it needs medication. I recognize why lifestyle changes should be considered first. For many POTS cases more salt, water, and exercise are all that is needed to control symptoms. However, there are some people who still cannot function with these changes.
No matter how much I exercise, drink water, wear compression, tilt my bed, and eat salt I still faint without a beta blocker. I still do all those things but lifestyle changes alone aren’t always enough in so many cases.
8. Blood Pressure Changes Have To Be Involved For Diagnoses
The diagnostic criteria for POTS are about pulse, not blood pressure. While some changes in blood pressure may occur during a tilt table test or upon standing POTS is not the same as orthostatic hypotension. Hyperadrenergic POTS can affect blood pressure as well, but does not have to be present for diagnosis.
9. POTS is Not Rare
1-3 million Americans have POTS and about 1% of teens have POTS. It is more common than both ALS and Parkinson’s Disease, but awareness is a huge problem. As a result, it doesn’t seem like there are that many of us or that POTS is worth researching. Awareness will help fix this.
For how common POTS is there is some exceptionally bad information out there. As a result, people are getting the wrong ideas about POTS. Dealing with misconceptions constantly becomes frustrating. What misconception are you sick of correcting?
Tilt table tests (TTT) are uncomfortable, expensive, and time-consuming. It is agreed that TTT should be the standard for POTS diagnosis, but wouldn’t it be great if we had a way to look for POTS without going through the entire test? Well, we can. The poor man’s tilt table test as it is called is a check at your heart rate and blood pressure throughout laying, sitting, and standing.
Chronically Ridiculous 