For international patients
PoTS Online Consultation
Video consultation in English for patients with postural orthostatic tachycardia syndrome (PoTS) who cannot find specialised care in their own country – a specialist second opinion with a written assessment and recommendations for your doctor at home.
Who this is for
Many patients with PoTS wait months or years for an appointment at one of the few specialised clinics in their country, or are not accepted at all. If you already have a diagnosis or a well-founded suspicion of PoTS and your findings are available, an online consultation can help you move forward: a structured review of what has been done so far, a clear assessment and recommendations your general practitioner can follow up at home.
Prim. Priv.-Doz. Dr. Robert Winker is a specialist in internal medicine and occupational medicine in Vienna, Austria, and treats patients with PoTS in his practice. Consultations are held in English or German.
From our research · Hypertension 2005
After three months: who still had orthostatic intolerance?
Filled dot = criteria still met · grey = no longer met
Symptom score (lower = better): training 1.79 → 1.04 · control 2.09 → 2.14
How it works
- 1
Book online
Book and pay for the package securely online (card, Apple Pay and others); you receive an invoice by e-mail and then choose your video appointment. Prefer to ask first? Send a short e-mail with your country and what has been done so far.
- 2
Secure upload of your records
After booking you receive a personal, secure upload link for your medical records: doctors’ letters, ECGs, Holter and blood pressure recordings, active stand or tilt-table test results, blood tests and a note of what you are currently taking – plus a short questionnaire on your symptoms, validated in our own 2003 study.
- 3
Review and video consultation
Dr. Winker reviews your records before the appointment. The video consultation (about 60 minutes, in English or German) covers your history, your symptoms in daily life, the existing findings and the options for managing PoTS – fluids and salt, compression, exercise training and pacing.
- 4
Written second opinion
Within a few days you receive a written summary in English with the assessment and concrete recommendations that you can hand to your general practitioner at home.
What an online consultation can and cannot do
- Assessment of your existing findings, a second opinion on the diagnosis and concrete recommendations (fluids and salt, compression, exercise training, pacing).
- Guidance on which examinations are still missing and should be arranged locally.
- No physical examination and no tests such as an active stand test, tilt-table test or ECG can be performed by video. You are welcome to see Dr. Winker in person in Vienna for these.
- This is a medical second opinion, not an online pharmacy or prescription service: nothing is prescribed, sold or dispensed. Ongoing care and monitoring remain with your general practitioner at home – for a review of your progress or an adjustment of the recommendations you are welcome to book a follow-up video consultation (€ 180) at any time. An online consultation is not suitable for emergencies.
Costs and reimbursement
The package is payable privately in advance online (card, Apple Pay and others); the invoice is issued in euros and no VAT is charged (Austrian small-business exemption). Whether your health insurer or region reimburses part of the costs – within the EU under the rules on cross-border healthcare – depends on your country and should be clarified with them beforehand. You receive an invoice suitable for submission.
Package
no VAT · payable in advance
- Review of your medical records before the appointment
- Video consultation, about 60 minutes
- Written second opinion and recommendations in English for your GP
if needed, per consultation
Secure payment (card, Apple Pay and others), then choose your video appointment
No suitable date? Ask by e-mailTell me your preferred dates – I reply personally, usually within two working days · also for questions
Prim. Priv.-Doz. Dr. Robert Winker
Specialist in Internal Medicine and Occupational Medicine, Vienna
Photo © Ludwig Schedl
About Dr. WinkerNot sure whether it is PoTS?
Take the self-check (ten questions, nothing stored) or read How do I recognise PoTS? and Exercise training in PoTS – 20 years on.
Prefer to come to Vienna?
In person at the Maschkangasse practice: initial consultation € 250 (including ECG, rhythm strip and blood sampling where needed), exercise ECG + € 150, detailed medical report + € 90 – or the complete PoTS package in Vienna for € 490. Services and fees
Why Dr Winker
Two decades of research on PoTS and orthostatic intolerance
PoTS is not a side topic for me: at the Medical University of Vienna I researched the causes, diagnosis and treatment of orthostatic intolerance for many years – in collaboration with the Autonomic Dysfunction Center at Vanderbilt University (Nashville), one of the leading centres worldwide.
Randomised exercise trial
First author of the randomised controlled trial of endurance training in orthostatic intolerance (Hypertension 2005) – awarded the Egmont Baumgartner Prize.
Diagnosis that works in daily life
The Schellong test compared with tilt-table testing (Wien Klin Wochenschr 2005) and workplace screening (Int Arch Occup Environ Health 2003, Egmont Baumgartner Prize 2002).
Research into causes
Genetic variants of circulatory regulation in PoTS – with Vanderbilt University (Hypertension 2005, Am J Med Sci 2003/2005, Int Arch Occup Environ Health 2005).
Internist and occupational physician
What PoTS means for exercise capacity, work and career – and how to document it clearly in a medical report.
Milestones
2001
First work on orthostatic intolerance in occupational medicine
2003
Workplace diagnosis – Egmont Baumgartner Prize
2005
Randomised exercise trial in Hypertension; Schellong vs tilt table
2005
Genetics of circulatory regulation with Vanderbilt University
2006
Complications of tilt testing (Clin Res Cardiol); syncope courses
2007
Egmont Baumgartner Prize for the exercise trial
2014–17
Autonomic regulation and arrhythmia (Circ Arrhythm Electrophysiol, Eur J Clin Invest)
today
Assessment, exercise plan and expert reports – in Vienna and online
What our studies show
From our research · Wien Klin Wochenschr 2005
Standing test (Schellong) compared with the tilt table – in PoTS
61 %
of tilt-confirmed PoTS cases were detected by the standing test – 14 of 23.
100 %
specificity: no abnormal standing test in people without PoTS.
An abnormal standing test is reliable – a normal one does not rule PoTS out. Hence several measurement days and, if the suspicion remains, a tilt-table test.
From our research · Int Arch Occup Environ Health 2003
The questionnaire you fill in beforehand is scientifically validated
Mean score (0–40)
93.5 % of people with an orthostatic dysregulation detected
Reliability (Cronbach’s α) 0.888
* Symptoms and heart-rate rise when upright with an exaggerated noradrenaline response.