To make an appointment at Mass General Brigham's Postural Orthostatic Tachycardia Syndrome (POTS) Clinic, call 617-732-7432.
Postural orthostatic tachycardia syndrome (POTS) is a syndrome characterized by reduced effective circulatory volume and excessive sympathetic nervous system activity, causing a number of bothersome autonomic symptoms. It is considered a syndrome—not a single disease—because it can have many potential causes.
Patients with POTS have symptoms that are most commonly triggered when upright. Patients have trouble regulating blood flow and controlling heart rate while upright. This can lead to reduced blood flow to the brain (known as cerebral perfusion) and an exaggerated “fight or flight” response from the sympathetic nervous system.
The Mass General Brigham POTS Clinic is one of the few dedicated programs in the country focused on POTS and related autonomic nervous system disorders. Staffed by a multidisciplinary team of specialists—including some of the nation’s few neurologists certified in autonomic disorders—the clinic offers comprehensive, personalized care grounded in the latest research.
Postural orthostatic tachycardia syndrome is more common than many people realize. Estimates are difficult to come by due to limited high-quality research in this area and historical under-recognition. Some authors estimate that between 1 and 3 million Americans are affected by POTS. This would make POTS more prevalent than multiple sclerosis, yet it remains underdiagnosed and often misunderstood.
Common POTS symptoms include:
Because POTS can stem from different underlying issues—and its symptoms can mimic those of other conditions—a thorough medical evaluation is essential to confirm the diagnosis and begin the right treatment.
Many people with POTS also experience nonspecific symptoms such as:
These symptoms can vary in severity and are also common in other diagnoses unrelated to autonomic nervous system dysfunction. Additional testing is sometimes needed to distinguish POTS from other possible diagnoses accounting for these symptoms.
POTS is diagnosed based on established clinical criteria from the American Autonomic Society and Heart Rhythm Society. Experts identify POTS in patients who meet the following guidelines:
Because other medical conditions can mimic POTS, a thorough evaluation is important. A simple test to measure your heart rate and blood pressure lying down and then standing, or one using a tilt table, can help determine whether you meet the criteria for diagnosis. Many patients experience similar symptoms but do not have the sustained increase in heart rate upon standing. While these individuals may still benefit from medical care, they would not meet the definition of POTS.
POTS can be diagnosed by a provider, as long as the patient meets the criteria above. Specialist care is important when the diagnosis is not certain, or when initial treatments are unsuccessful. Neurologists, cardiologists, and electrophysiologists are often familiar with evaluating symptoms like rapid heart rate, dizziness, and fatigue.
Mass General Brigham is home to one of the few multidisciplinary teams in the country with board-certified specialists who focus exclusively on autonomic disorders like POTS. Seeing experts with this level of experience helps ensure a timely and accurate diagnosis.
Your first visit to the Mass General Brigham POTS Clinic will be scheduled with a provider who has subspecialty expertise in autonomic neurology. This appointment will last about one hour.
To help your care team prepare, we encourage you to complete any pre-visit questionnaires in advance before your appointment.
During your visit, your physician or advanced practice provider may review:
Based on this assessment, your provider may order additional lab tests to rule out other conditions that mimic POTS. You may also be scheduled for an autonomic reflex function test if you haven’t had one before. Additional testing may be recommended and booked separately, depending on your specific symptoms and needs.
Once a POTS diagnosis is confirmed, your care team will work with you to develop a personalized treatment plan. The Mass General Brigham POTS Clinic is interdisciplinary, meaning we take a team-based approach to diagnosis and treatment that may include specialists across multiple fields, depending on your needs.
You may be referred to other specialists for co-management, such as:
If additional testing or treatment is recommended, we will schedule follow-up visits with one of our POTS specialists.
We also provide patients with ongoing education around their diagnosis, symptom management, and long-term care strategies. If you have other diagnoses, we’ll encourage continued collaboration with your existing specialists or help you establish new care as needed.
For those interested, there may be opportunities to participate in research studies aimed at advancing understanding and treatment of POTS.
There is no one-size-fits-all approach to treating postural orthostatic tachycardia syndrome. POTS treatment is highly individualized and based on your specific symptoms, medical history, and overall health. Your care team will work with you to develop a personalized plan. The goal is to improve your daily functioning and reduce symptom severity—often through a combination of lifestyle changes, physical therapy, and medications.
Many patients benefit from non-medication strategies that help regulate blood flow and reduce symptoms. These may include:
If lifestyle adjustments aren't enough on their own, medications may be used to support blood volume, stabilize heart rate, and improve blood flow. These can include:
Your provider may also adjust treatment based on coexisting conditions, such as migraines, autoimmune disorders, or gastrointestinal issues.
The length of POTS treatment depends on how your symptoms improve over time. Every patient is different, and care plans are tailored to your individual needs.
Yes, we welcome referrals from across the United States. Many of our providers offer telehealth visits, depending on licensing regulations, insurance coverage, and whether virtual care is clinically appropriate.
We accept referrals for international patients on a case-by-case basis, primarily for one-time consultations or second opinions.
Because there are so few autonomic specialists in the United States, we prioritize our focus on evaluating and managing patients with autonomic disorders over administrative tasks. We generally ask that disability paperwork be completed by your primary care provider or a specialist in work capacity evaluations, such as a physiatrist or occupational therapist. These providers can review our clinical notes through medical records and incorporate our findings into their report.
To request your records, contact the Massachusetts General Hospital operator at 617-726-2000 and ask for Medical Records, or access them directly on Patient Gateway.
Thank you for your generosity and interest in supporting our work! There are several ways you can give back to the POTS community, including volunteering for research studies or donating to the MGB POTS Clinic or the Mass General Brigham Small Fiber and Autonomic Neurology Program. Your support helps us advance care and research for patients living with POTS.
For more information, please contact:
Sally C. Mooney, Associate Vice President, Development
scmooney@bwh.harvard.edu or 917-796-0710
The Mass General Brigham POTS Clinic brings together a multidisciplinary team with deep expertise in diagnosing and treating POTS. Our care team includes:
Autonomic neurologists and cardiologists with deep experience in evaluating complex symptoms and managing autonomic disorders
Advanced practice providers who support diagnosis, treatment planning, and follow-up care
Allied health professionals, including physical therapists, psychotherapists, and nutritionists, who provide personalized support for symptoms that affect daily life
At the Mass General Brigham POTS Clinic, we are actively engaged in research to better understand POTS and improve how it is treated. Our team collaborates closely with researchers across Mass General Brigham and Harvard University to explore the causes of POTS, how it affects the body, and which treatments offer the most benefit.
We are deeply grateful to the individuals who participate in our research studies. Their contributions are essential to advancing care for people living with POTS.
To learn more about current research efforts, Additional details about ongoing POTS research can be found here. If you are interested in participating in or supporting or autonomic research program, please email us at MGBSFANResearch@mgb.org.
Please note: Typically, before we consider you for enrollment in our research studies, you will need to have had a clinical evaluation in our POTS clinic.
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