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Services
POTS, orthostatic intolerance and broader autonomic-cardiovascular pictures rarely declare themselves through a single in-clinic measurement. Heart rate sits in a normal range at rest. Blood pressure looks fine seated. Yet across the day, standing produces tachycardia, meals produce blood-pressure drops, exertion produces autonomic load that does not return to baseline before the next demand. The clinical picture is in the movement, not the snapshot.
Cardiac investigations in this pathway are the structured tools that capture that movement. A Holter monitor records continuous ECG over 24 hours or longer and shows what the heart is doing across sleep, ordinary activity, meals and exertion. An ambulatory blood pressure monitor (ABPM) records blood pressure repeatedly across the day and night, capturing the postural changes, post-prandial drops and circadian patterns that single readings miss. The NASA Lean Test is a structured 10-minute standing protocol that measures heart rate and blood pressure responses against a standardised position, producing a defined diagnostic picture rather than impression.
Together, these investigations make it possible to read which POTS phenotype is in front of the clinician. High-flow POTS produces a different heart-rate trajectory than hypovolaemic POTS. Hyperadrenergic POTS shows specific blood-pressure and heart-rate patterns. Neuropathic POTS sits differently again. The same standing heart-rate rise can mean clinically different things, and the choice of management depends on which picture is actually there.
This service is for people in the dysautonomia or connective tissue pathways with suspected or diagnosed POTS, orthostatic intolerance, or other autonomic-cardiovascular pictures where structured investigation will change the management. It is also for people with diagnosed POTS whose previous management has not fitted, and who need a sub-pattern read.
The first appointment reads the clinical picture and decides which investigations will actually change the management. Where the picture is already clear and investigation will not add to the plan, that is named. Where investigation is the right next step, the specific test and its purpose are explained.
Holter monitors, ambulatory blood pressure monitors, NASA Lean Test protocols, or other indicated investigations are arranged. Equipment is fitted and the patient is given clear instructions on what to do across the recording period.
The recording captures the body across ordinary activity. The patient is asked to keep a simple symptom diary alongside, so the data can be read against what the body was doing at the time.
The data is analysed by a clinician with experience in autonomic-cardiovascular phenotyping. The heart rate trajectory across positions, blood-pressure response patterns, circadian variation and symptom-data alignment are read together. Where the picture fits a recognised POTS phenotype or other autonomic-cardiovascular pattern, that is named.
The findings are held inside the biio. record so the rest of the team — autonomic medicine, medication management, exercise physiology, dietetics — can build on the same picture. Where further specialist cardiology referral is the right next step, that is made through the same record.
The autonomic-cardiovascular picture moves with treatment, illness, hormonal change and other variables. Where re-investigation across treatment is appropriate, that is planned rather than left to ad-hoc request.
When the cardiac investigation work is going well, the autonomic-cardiovascular picture becomes legible. The POTS sub-pattern is named. The blood-pressure pattern is described. Management decisions — fluid and electrolyte strategy, medication choice, exercise prescription — can be made against the actual physiology rather than against impression. Other clinicians inheriting the patient inherit a real diagnostic picture rather than a label.
Cardiac investigations do not, by themselves, treat anything. The investigation is a description of what the body is doing, not a treatment of why. What the description can do is make the rest of the clinical work more accurate — and in a presentation where the difference between phenotypes is often the difference between a medication working and a medication doing harm, that often matters more than it looks.