Updated 10 October 2026
At a glance
- The American Heart Association says to note in the diary the time of day symptoms began and what you were doing, and to write it down if in doubt.
- A hospital diary sheet says to use the time on the monitor to record any symptoms, and a clinic sheet says the time must come from the monitor rather than a watch or phone.
- A table of diary columns, a monitor-week diary, a word list, four steps and a one-page summary follow below.
- POTS Journey can hold standing entries and symptom entries for the same week, and its Doctor Report prints a page to hand over with the monitor.
Wearing a Holter monitor for a day or two is a short window, and the diary is the one part of the test that only you can supply. For people with POTS the diary has extra work to do, because standing, sitting and lying down each belong on the line.
This guide sets out what the American Heart Association, two diary sheets from cardiology services, a device maker and a 2021 study say about the diary, then offers a table, a monitor-week diary, a word list, four steps and a one-page summary. What the recording shows is for your cardiology team to say.
What the American Heart Association and hospital diary sheets say about keeping a monitor diary
The American Heart Association writes: "While you are being monitored by a Holter monitor, it's important to keep an accurate diary of your activities and symptoms during the test." It says: "If you feel symptoms such as chest pain, shortness of breath, uneven heartbeats or dizziness, note in your diary the time of day they began and what you were doing." And it closes with: "If in doubt, write it down."
A hospital diary sheet from Cambridge says: "Use the time on the monitor to record any symptoms." A clinic diary adds: "The time must be taken from the monitor and not a watch, computer, phone, or other clock." It also gives examples of activities, such as exercise, walking, climbing or heavy working.
The Boston Scientific diary explains why: "It's important to keep an accurate diary of your symptoms and activities so your physician can learn how your heart responds to your lifestyle. Your diary will be compared to the changes in your ECG recorded by the monitor."
A 2021 retrospective study of 64 people with a POTS diagnosis who were found to have a second rhythm problem, supraventricular tachycardia, noted that the two conditions have "distinctive features but overlapping clinical manifestations" and concluded that "Underlying SVT in patients with POTS can be missed easily." The authors favored long-term ambulatory rhythm monitoring. This is research on a small group, and your cardiologist decides what is relevant to you.
None of these sources describes a diary as a diagnosis. They describe it as the account that is compared with the recording, which is why its clock matters. A diary written well also helps in the other direction: when the recording shows a rhythm change at a particular minute, the diary is the only place that says whether you were standing, eating, climbing stairs or lying still. In POTS, where position is so often part of the story, that single piece of context can matter more than any amount of detail about the symptom itself.
Symptom entries can be dated in the Daily Journal within POTS Journey (by Health Journey Labs), with the monitor clock time written into each one.
A table of diary columns: what each source asks you to write for your cardiology clinician
The sources ask for similar things in slightly different words. The table lines them up.
Diary columns table, by POTS Journey
| Source | Time | Activity | Symptoms | Other points |
|---|---|---|---|---|
| American Heart Association | Time of day for every entry | Sitting, walking, strenuous exercise, eating, medications | Chest pain, dizziness, nausea, other pain, whether or not important | Write it down if in doubt |
| Cambridge University Hospitals | Time as seen on the monitor | Activity | Symptoms | Use the monitor clock |
| TotalCardiology | Taken from the monitor, not another clock | Examples such as exercise or walking | Palpitations, dizziness, nausea, anxiety | An Other column for description |
| Boston Scientific | Date plus clock time | Activity chosen at the time | At least one symptom | Press the event button when a symptom occurs |
| POTS overlay (yours) | Clock time | Lying, sitting, standing, walking | Heart pounding, dizziness, fatigue | Position before the symptom started |
Notice that none of the printed forms has a position column, though standing is central in POTS. Adding one is a small change that helps the reader see what happened right before a symptom. The guide to tilt table and active stand tests explains how standing is measured in the clinic, and this table concerns a monitor worn at home.
POTS Journey gives a standing entry and a symptom entry their own places for the same hour, mirroring the table's columns.
A monitor-week diary with standing and symptom lines to bring back to the cardiology visit
A diary for a one- or two-day monitor needs only a handful of columns. Sample rows are invented to show the layout.
Monitor-week diary table, by POTS Journey
| Monitor clock time | Position | Activity | Symptom | Button pressed | Notes |
|---|---|---|---|---|---|
| 07:45 | Lying to standing | Getting up | Heart pounding, dizzy | Yes | Settled after sitting |
| 10:20 | Sitting | Desk work | None noticed | No | Quiet period |
| 13:05 | Standing | In a queue | Lightheaded | Yes | Leaned on a wall |
| 21:40 | Lying | Reading | Fluttering | Yes | Lasted a few minutes |
Write the time from the monitor, not from your phone, as the sheets say. Press the event button if your device has one and note that you pressed it, since the Boston Scientific sheet describes pressing the button when a symptom occurs. If a symptom feels minor, write it anyway: the American Heart Association says to record symptoms "whether or not you feel they are important." Add the position column if the form lacks one.
A quiet row is worth keeping, because it shows what an ordinary stretch looked like. Rows for meals, showers and trips to the bathroom are worth adding as well, since these are the moments when posture changes quickly and a reader may want to match them against the recording. If your day included heat, a poor night's sleep or an illness, one line at the top of the page saying so gives the reader the background without crowding the rows. Tidy the page when the monitor goes back, rather than before, so that the notes stay in order. For tracking beyond the monitor week, the guide to starting a POTS symptom log suggests a longer layout.
The diary rows can be typed into the Daily Journal of POTS Journey as you go, so the paper form only needs copying at the end.
Words for your cardiology clinician about standing, rhythm and symptoms during a monitor week
Short repeated words make the diary easy to scan.
Words for your cardiology clinician
For the cardiology clinician, POTS Journey suggests the position words below.
- Position words: lying, sitting, standing, stood up quickly, standing still, walking.
- Activity words: shower, meal, stairs, queue, desk, exercise, rest.
- Symptom words: heart pounding, fluttering, lightheaded, dizzy, fatigue, nausea, chest discomfort, none noticed.
- Device words: button pressed, electrode loose, monitor clock checked.
- Question words: what was recorded at this time, how does it compare, what happens next.
Pick the words that fit each entry. If none fits, write a short sentence of your own and keep the list for the routine rows. Using the same word for the same feeling from entry to entry matters, because a change in vocabulary can look like a change in the symptom when nothing has moved. Dizzy and lightheaded can mean different things to different people, so decide which you mean and keep to it for the week. The list captures what happened and makes no claim about the cause. Chest pain, fainting, or palpitations that feel severe call for urgent care and your local emergency number before any diary, and the diary can be completed afterwards from what you remember and from the monitor clinic's instructions.
On the next monitor day, the Daily Journal of POTS Journey can take these same words again.
Four steps before returning the monitor and the cardiology clinician appointment
Handing the monitor back is the moment the diary has to be complete. Four steps help.
Steps for the monitor week, by POTS Journey
- Check every row has a monitor clock time.
- Add a position to each symptom row.
- Mark the rows where you pressed the button.
- Write two or three questions for the results visit.
From POTS Journey, we recommend doing the check the evening the monitor comes off (POTS Journey checklist), while the day is still fresh.
Plain questions work well: what the recording showed at the times you marked, how the results will reach you, and what the next step is. The American Heart Association says your doctor needs a complete picture of your activities, so a diary with gaps can be filled in by memory while it is still recent. The guide to tracking POTS labs beside heart rate and standing weeks covers the results side.
At the results visit, write each answer under its question and add the date of the next contact. If the clinic wants a longer or repeated recording, record the request date and the booking date as two lines, and keep any instructions for wearing the monitor, since these are easy to lose between the booking and the day itself. If the monitor was fitted elsewhere, note where, so that a report can be requested.
Questions stored under the right name in My Care Team of POTS Journey are ready when that clinician walks in.
A one-page summary for the cardiology clinician: the monitor week, symptoms and questions
One page lets the reader match your diary against the recording quickly, with the paper form behind it.
One-page monitor summary, by POTS Journey
- Dates and monitor clock times of the recording.
- Each symptom with its clock time and position.
- Rows where the event button was pressed.
- Anything unusual about the days, such as heat, illness or a poor night.
- Questions for the results visit.
Hand over the page with the paper diary, and offer to read it row by row. Write each reply with its date. If a different clinician reads the recording than the one who fitted the monitor, the page lets the second reader see your week without a retelling, and it gives you a reference if you are asked about a particular moment later on.
The page copies what you recorded. What the monitor showed and what follows from it belong to your cardiology team, and no source, page or app decides it. If symptoms turn severe, your local emergency number is the first call.
With the entries in POTS Journey, its Doctor Report can print this page the moment it is needed.
How POTS Journey can help
A diary with a clock on every line gives the recording its context. If you want the longer record kept in one place, the best POTS apps guide compares the options.
POTS Journey is a personal pots tracker from Health Journey Labs on the App Store and Google Play. Clock time, position and symptom on each line make a monitor week readable. What the recording shows and what comes next belong to the cardiology team, and a clean diary lets them begin from the facts. Below is what you can use and how each part helps.
- Daily check-in — Logs physical symptoms, emotional state, nutrition, sleep, exercise, meds, external factors; app-specific items: upright load, heart-rate context, heat, fluids, fog, recovery; read together with the rest of the logged history.
- Daily Journal — Logs free-text notes, voice entry; app-specific items: what upright time cost, heat context, partner talks, visit debriefs, leftover guilt after you canceled, a look-fine mismatch line; read together with scores and other logged history (adds context).
- Flare Tracker — Logs flag a day clearly worse than the usual hard week, onset, intensity, short note; app-specific items: upright dizziness, racing heart, heat crash, fog; read together with history across weeks (one-off spike vs repeating pattern).
- Weekly Goals — Logs one small aim, whether it held; read together with real check-ins.
- My Meds — Logs medicine names, timing, dose; app-specific items: options you already take as prescribed — fluids/salt plans your clinician set, compression notes, other treatments; read together with upright weeks, sleep, heat days, the rest of the tracked history.
- My Labs — Logs result dates; app-specific items: tilt-table notes, blood counts, iron, thyroid, other tests; read together with upright symptoms, fog, function.
- My Care Team — Logs clinicians, short visit notes; app-specific items: tends to ask mainly about heart rate rather than function; read together with logged history; used for: visit prep (what to ask and bring); notes during the visit; review afterward.
- Doctor Report — Logs one-page summary exported from logged history; app-specific items: dates, upright symptoms, heat, fluids, fog, how you functioned; read together with the history already logged; visit type: cardiology or neurology.
- Learn — Logs short education topics, prompts; app-specific items: upright load, heat, pacing, visit prep, upright symptoms on days that look fine; read together with your own logged weeks.
- AI companions — Logs Clara (general chat), specialist companions; app-specific items: knowledge, fitness, nutrition, relationships; read together with your logged history (companions already see it); used for: visit wording; a calm partner script; a soft rain-check line; a listening ear after a hard upright or heat day.
- Food Tracker — Logs meal or drink lines, caffeine, alcohol; read together with energy and symptoms.
- Weight Tracker — Logs scale or body notes; read together with the rest of the logged history.
- Period Tracker — Logs start and stop dates, flow, how heavy or light bleeding felt; read together with upright symptoms, fog, heat, everything else logged.
- My Assessments — Logs structured check-ins beyond daily scores, onboarding life and social context; read together with ongoing history.
Everything you log builds one history, and insights get stronger as it grows. Custom symptoms let you add your own labels.
We make POTS Journey at Health Journey Labs. This guide is educational and does not replace medical advice. Diagnosis, medication decisions, and urgent care decisions belong with your treating clinicians.
Sources
- American Heart Association: Holter monitor diary
- Cambridge University Hospitals: Holter symptom diary
- TotalCardiology: Holter monitor diary
- Boston Scientific: BodyGuardian MINI Holter diary
- Journal of Innovations in Cardiac Rhythm Management 2021: supraventricular tachycardia and POTS overlap (PubMed 33654569)
FAQ
The answers below draw on the sources cited in this guide, and the app they mention is POTS Journey (by Health Journey Labs).
Why does the diary use the monitor clock?
The TotalCardiology sheet says the time must be taken from the monitor itself, in place of a watch, computer or phone. The recording and the diary then line up row by row for the person reading them.
Typing the monitor clock time into each entry in POTS Journey as you go keeps that match, and a short remark when the clocks differ explains any small gap to the person who reads both together.
What does the American Heart Association say to write?
It says to note in your diary the time of day symptoms began and what you were doing, to record symptoms whether or not you feel they are important, and that if in doubt, write it down.
A short entry for each moment, made in the Daily Journal of POTS Journey while it is happening, takes less effort than rebuilding the whole day from memory at the end of a tiring evening.
Should I add a position column?
The printed forms leave one out, and POTS makes position central. Adding lying, sitting or standing to each symptom row is a small change that gives the reader the context of the moment.
A position field on every entry in POTS Journey turns each symptom into a pair, symptom and position, which a cardiologist can read down the page and compare across the whole recording.
What is the event button for?
The Boston Scientific sheet describes pressing the center button once when you feel a symptom, then recording the date and the clock time and choosing an activity and a symptom. Your own device sheet explains how yours works.
A button-pressed flag on the entry in POTS Journey lets the reader find the rows that the recording will mark, and cross-check them quickly against the rows that you wrote down yourself.
What did the 2021 study of POTS and a second rhythm problem find?
It analyzed 64 people with a POTS diagnosis and a second rhythm problem, supraventricular tachycardia, and concluded that the second problem can be missed easily. It describes a small group, and your cardiologist decides what applies to you.
Bringing a clear monitor diary from POTS Journey gives your cardiologist a record of your own symptoms alongside the rhythm data, which is the pairing that a study like this one depends on.
What if I forget to write something during the day?
Add it as soon as you remember and mark it as written afterwards. The American Heart Association says to write it down if in doubt, so an entry marked as added later is better than a gap.
An entry added afterwards in POTS Journey can say so in its note, and the original day stays in order, so the reader sees exactly what was written when and what was filled in from memory.
Can the diary cover more than the monitor week?
Yes. The same columns work for ordinary weeks, and a longer record shows how a monitor week compares with other weeks. Your cardiology team says which period matters for the recording.
The entries made during the monitor week stay in POTS Journey with their dates, so they sit in the same history as the weeks before and after and can be compared directly by a reader.
What about symptoms that feel severe?
Severe chest pain, fainting or palpitations that feel alarming call for urgent care and your local emergency number first. The diary can be completed afterwards from what you remember and from the clinic's instructions.
Following an urgent episode, a line in POTS Journey with the date and what happened gives the cardiology team a written account that was made close to the event, while memory is still fresh.
Who should receive the one-page summary?
Your cardiology team and primary care may each see part of the story, and one shared page lets both read the same times and the same wording at the same moment during follow-up care.
Both offices are handed the same printout from POTS Journey, and the date printed on the page shows which copy is current whenever two versions turn up together in the same chart.
Can an AI chat read my diary?
It can tidy notes and shape questions about what to ask, while reading the recording is the job of your cardiology team. Severe symptoms call for emergency care before any chat or any note.
Once rows are filed, the companion in POTS Journey can list them back briefly, of the entries you filed, each traceable to a row you wrote, while the meaning of the recording stays with your clinicians.
How do I keep the paper form and the app in step?
Pick one as the master. Many people carry the paper form during the day and copy it into the app in the evening, and the copy keeps the times exactly as written on the form.
Typing the rows into POTS Journey when the monitor comes off gives you a searchable copy of the week, and the paper form goes back with the monitor as the clinic asks you to do.
What should I take to the results visit?
Take the one-page summary, a copy of the diary, the date the monitor was worn and two or three questions about the results. One page reads quickly, and the form carries the detail.
The page is prepared in POTS Journey before you leave home, and the dated entries stay on the phone for any moment the clinician wants to look at during the results appointment.
How much history should I bring from before the monitor?
Bring what you can date reliably. The sources describe the monitor week only, so the cardiology team's preference decides how much earlier history helps, and approximate dates marked with a question mark are acceptable.
Earlier symptom entries kept in POTS Journey sit under their real dates, so a clinician can read the weeks before the monitor in order and see how the monitor week fits into the picture.
Who should see my symptom notes, and what about privacy?
Heart rate readings, fainting episodes and notes on school or work absences can be misread as anxiety by someone who does not know POTS. Lock the device and share the standing heart rate summary only with the clinicians and offices that ask for it.
Entries in POTS Journey belong to you as health notes. Its privacy policy describes how data is stored and handled; check it before you decide what to record. Nothing here is medical advice.