Monitoring
In the absence of robust evidence, monitoring in POTS is based on clinical practice, which may vary between organizations; check your local protocols.
Organize a follow-up appointment 8 weeks after starting nonpharmacologic measures, or starting or changing pharmacologic treatment.
Check:
Electrolytes at 1 week, and 1 month following initiation of fludrocortisone or desmopressin
CBC after 1 week, and then monthly after starting erythropoietin.
Consider loop recorder implantation for certain patients. The purpose of loop recorder implantation is to look for causes of a patient’s symptoms other than POTS, and to monitor the patient for bradycardia or sinus pauses if the patient has syncope. Therefore, schedule loop recorder implantation if the patient:
Has ongoing symptoms that do not respond to treatment
Reports symptoms suggestive of supraventricular tachycardia or frequent syncope, without an identifiable cardiac rhythm abnormality on an event monitor.
Consider 24-hour urinary sodium to assess for hypovolemia if the patient is not responding to treatment or supplemental salt intake is suspected to be suboptimal.[4]
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