What treatments options may be considered in patients with POTS who also need daily diuretics to treat heart failure and are already wearing compression garments?

Given the epidemiology of POTS and congestive heart failure, you are far more likely to see a patient with neurogenic orthostatic hypotension and CHF than POTS and CHF. I have an article on NOH and CHF in Autonomic Neuroscience 2020.

The principals are basically the same however because the management strategies can be contradictory.

1. I would probably prefer metoprolol to carvedilol as it is a better rate control agent for POTS, based on the Swedish literature from the 70s, you could make a case for propranolol which is even better for POTS as they were using it in CHF patients then, before MERIT-HF came out. I would then add ivabradine as a second line agent for tachycardia. I would avoid verapamil, diltiazem and clonidine/guanfacine if ...

Dr. @Dr. First Last already has listed an excellent answer. So, I will only add some brief comments. Your question has unspoken nuances to it - does the patient have diastolic or systolic heart failure? Is it truly POTS or orthostatic hypotension as Dr. Muldowney suggested? Orthostasis will certainly limit GDMT. We run into the issue of comorbid orthostasis and heart failure quite frequently with our cardiac amyloid patients. Commonly, these patients will be treated with SGLT2i + MRA + loop diuretic + midodrine (+ AL or TTR amyloid treatment). Certainly would avoid fludrocortisone in a HF patient. Droxidopa can often benefit those who don't respond to midodrine.

Diuresis is ultimately targeted at the volume, while the use of midodrine or dr...

I do not use midodrine.