Table 10.

Orthostatic testing.

In-office standing tests
Five minutes supine, then at least 10 min of quiet standing, leaning against a wall, with instructions to the young person to remain still, not fidget or shift her/his weight. Changes in HR and BP should be recorded each minute, supine and upright, along with intensity of orthostatic symptoms and fatigue on a 0–10 scale. The patient must be carefully observed due to the risk of syncope. The development of pallor, warmth, and/or nausea can be prodromal signs of hypotension or syncope. This test will identify POTS and orthostatic hypotension (OH), but is usually not sufficiently prolonged for neurally mediated hypotension (NMH)
Head-up tilt table tests
HR and BP are measured supine and during 70° head-up tilt. POTS or OH can be identified by 10 min tests. Prolonged testing of 40–45 min might be required to identify NMH

For further details on orthostatic testing and standing test data sheet see Appendix G.