If you’re experiencing symptoms like dizziness, lightheadedness, fainting, or a racing heart when you stand, your healthcare provider may suspect a form of dysautonomia—including postural orthostatic tachycardia syndrome (POTS). Because these symptoms can stem from many different conditions, getting an accurate diagnosis matters. One of the most common tools used during evaluation is the tilt table test.
Below, we explain what the test is, what happens during it, and what the results can (and cannot) tell you. We cover:
What Is a Tilt Table Test for POTS?
A tilt table test measures how your heart rate, heart rhythm, and blood pressure respond as your body moves from lying down to an upright position.
For POTS, clinicians are looking for a significant increase in heart rate when the patient is tilted toward a standing position—without a major drop in blood pressure. The test is designed to safely reproduce symptoms in a controlled environment.
Although often used to evaluate POTS, the test can also help diagnose other autonomic or cardiovascular conditions, such as:
- Vasovagal syncope (fainting triggered by exaggerated autonomic responses)
- Orthostatic hypotension (a drop in blood pressure upon standing)
- Arrhythmias
- Structural heart disease
What Happens During a Tilt Table Test?
The tilt table test is non-invasive, and most patients require only minimal preparation.
Before the Test
Your care team will review instructions with you. Guidelines typically include avoiding food or drink for about four hours beforehand and skipping caffeine on the day of the test. Most prescription medications are able to be taken as usual unless your provider specifically asks you to stop medications that influence heart rate or blood pressure.
When you arrive:
- A provider helps you lie down safely on the motorized tilt table.
- You may have an IV placed to allow for blood draws or medication if needed.
- Blood pressure cuffs or continuous blood pressure monitors are applied.
- Electrodes are placed on your chest (and sometimes your limbs) to record heart activity via ECG.
During the Test
The test has several phases:
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Baseline phase: You lie flat for about 15 minutes while your baseline heart rate and blood pressure are recorded.
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Tilting phase: The table slowly tilts upward, pausing at intervals for monitoring. Once you reach approximately 70 degrees, you remain in that position for 20 to 45 minutes while providers monitor your symptoms and vital signs.
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Medication phase (if needed): If your blood pressure and heart rate stay stable, clinicians may administer medication to provoke a response and better understand how your body reacts. Afterward, you may be tilted again to around 60 degrees for additional monitoring.
After the Test
When the test is complete, the table returns to the flat position. You may rest for several minutes while any lingering symptoms resolve. Most patients feel well enough to go home shortly afterward, though it’s wise to have someone drive you.
Is the Tilt Table Test Safe?
The tilt table test is considered safe, but it is designed to trigger your symptoms. Dizziness, nausea, sweating, blurred vision, or palpitations may occur during the upright period. These usually resolve quickly once the table is lowered.
Serious complications—such as heart attack or stroke—are extremely rare and typically affect only patients with significant underlying cardiovascular disease. Your doctor will review risks and adjust the test if necessary.
What Do the Test Results Mean?
Clinicians interpret the test based on changes in heart rate, blood pressure, symptoms, and whether fainting occurs.
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Positive result for POTS: A sustained increase in heart rate of at least 30 beats per minute (or 40 bpm in adolescents) within 10 minutes of standing without a significant blood pressure drop.
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Negative result: Heart rate and blood pressure remain stable, and no concerning symptoms appear. This suggests no abnormal autonomic response during the test.
The test may also indicate other forms of dysautonomia or orthostatic conditions, depending on the pattern of changes.
Who Performs the Test?
Tilt table tests are typically conducted by:
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Nurses or cardiac technicians – They prepare you for the test, operate the equipment, and monitor your vitals.
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Cardiologists or electrophysiologists – They supervise the procedure, analyze the results, and determine next steps.
Where Can You Get a Tilt Table Test?
Many hospitals and large outpatient clinics offer tilt table testing. You can locate a testing facility by:
- Checking hospital system directories (e.g., Mayo Clinic, Cleveland Clinic).
- Using your insurance provider’s “find a facility” tool.
- Searching online platforms like Zocdoc.
- Asking your primary care provider or cardiologist for a referral.
- Searching “POTS treatment near me” in search engines like Google.
Can a Tilt Table Test Diagnose POTS?
Not by itself. A tilt table test is considered the gold standard tool for documenting the heart rate increase seen in POTS, but a full diagnosis also requires:
- Chronic symptoms of POTS for at least three months.
- Symptoms that worsen upright and improve when lying down.
- An absence of other medical conditions that explain the heart rate increase.
Additional evaluation—including symptom history and sometimes other autonomic testing—is important for an accurate diagnosis.
If your test is positive or inconclusive and you still experience symptoms, your provider may order additional tests to rule out other causes or better classify your dysautonomia.
Common follow-up tests include:
- Standing test (a simpler alternative to the tilt table test)
- ECG
- Blood and urine tests
- Holter monitor for 24–48 hours
- QSART, Valsalva maneuver, or norepinephrine testing
What to Do If You’re Diagnosed with POTS
Finding effective care for POTS can be more challenging than you would expect. Many patients try everything they’re told—drink electrolytes, wear compression socks, do gentle exercise—yet still find themselves dealing with dizzy spells, brain fog, and exhaustion that never seems to fully go away.
That’s because most healthcare providers approach POTS as a cardiovascular issue—focusing on heart rate, blood pressure, and blood flow—without asking why those systems became unstable in the first place.
The reality is that POTS isn’t just a cardio problem. As we mentioned above, it’s a form of dysautonomia, or dysfunction of the autonomic nervous system (ANS)—the part of the brain and body that naturally regulates heart rate, breathing, and blood flow.
When that system isn’t working properly, it can lead to orthostatic intolerance and the symptoms that we associate with POTS: lightheadedness, fainting episodes, palpitations, chest pain, fatigue, and more.
When choosing a POTS treatment provider, whenever possible, choose one that understands and treats this neurological root cause. With tailored neurological therapy, it is possible to retrain your autonomic nervous system, providing long term regregulation gains and sustainable quality of life improvements (not just short-term symptom relief). This is the approach we take to treating POTS at Cognitive FX.
Read this article to learn more about how to evaluate POTS treatment providers.
Treating the Neurological Root Causes of POTS at Cognitive FX
Our 4-day program grew out of the success we’ve had treating concussion patients who commonly experience POTS symptoms. As we consistently saw their autonomic function improve through neurological rehabilitation, we refined and formalized those methods into a dedicated POTS treatment.
The Four-Day POTS Treatment Program
Cognitive FX does not diagnose POTS, but we offer an intensive, four-day POTS treatment program for patients who already have a confirmed diagnosis.
Our approach focuses on retraining autonomic regulation, using a carefully designed set of therapies that target different components of ANS dysfunction:
- Comprehensive neurological and physiological assessment
- Neuro-cardio training
- Vestibular recalibration
- Breathing mechanics training
- Cranial nerve activation
- CO₂-based therapies
Each modality addresses a different dimension of autonomic regulation, helping the brain relearn how to communicate effectively with the cardiovascular system.
Neuro-Cardio Training
POTS patients often remain stuck in sympathetic overactivation. Our interval-based approach alternates short bursts of exertion (activating the sympathetic system) with guided recovery strategies—cooling, diaphragmatic breathing, and sensory inputs—to activate the parasympathetic system. Repeating these cycles teaches smoother transitions between “fight-or-flight” and “rest-and-digest.”
Vestibular Recalibration
A small inner-ear structure called the saccule helps the brain detect vertical movement. When saccular signaling is inaccurate, the brain may overreact to posture changes, causing dizziness or tachycardia. Our vestibular therapy helps recalibrate these signals and reduce symptom spikes during movement.
Breathing Mechanics Training
Breathing directly affects autonomic tone. Many POTS patients breathe shallowly and chronically lower their CO₂ levels, worsening dizziness and fatigue. We teach proper diaphragmatic breathing and use supplemental CO₂ when appropriate to restore balance.
Cranial Nerve Activation
Taste and smell exercises (lavender, vanilla, citrus, mint, and others) stimulate parasympathetic or sympathetic pathways. Activating these cranial nerves helps reinforce healthy autonomic signaling.
CO₂-Based Therapies
CO₂ is essential for oxygen delivery. Many POTS patients run low on CO₂, limiting their ability to tolerate exercise. We use CO₂ inhalation to prepare patients for cardio intervals, and a CO₂ “bath” afterward to enhance relaxation and recovery.
Each therapy targets a different aspect of dysautonomia, teaching the brain how to self-regulate more effectively. Each patient is provided with education about what POTS is and how neuro training helps.
If you’ve been diagnosed with POTS and you live in the Utah Valley area—or can travel to Provo—our clinic offers one of the few neurologically focused POTS treatment programs in the country. Fill out this form to see if you’re a good fit for our program. Or, call our patient care coordinator at 385-334-6093.
