Understanding POTS: A Guide for New Yorkers Searching for Answers
Understanding POTS:
A Guide for New Yorkers Searching for Answers
By Dr. Amnon (Ami) Beniaminovitz, MD, FACC
Founder & Cardiologist, Vivify Medical
I've had too many patients come to Vivify Medical telling me the same story: years of debilitating symptoms, normal test results, and being told "maybe it's just stress."
One of them finally got diagnosed with POTS (Postural Orthostatic Tachycardia Syndrome) after years of searching for answers.
What is POTS?
When you stand up, gravity pulls blood toward your legs. Your autonomic nervous system normally responds instantly, blood vessels constrict, heart rate increases slightly, and blood keeps flowing to your brain.
In POTS, this automatic adjustment doesn't work properly. Heart rate can spike by 30+ beats per minute within 10 minutes of standing. Blood pools in the lower body. The brain receives less blood flow, leading to lightheadedness, fatigue, brain fog, palpitations, and exercise intolerance.
It primarily affects young adults, with women disproportionately represented. Many cases are triggered by viral illness, pregnancy, or physical trauma.
Why proper evaluation matters:
Standard cardiac tests often appear normal because they're not designed to assess autonomic function. POTS requires specific testing to measure how your body responds to positional changes.
Symptoms can overlap with other conditions, which makes getting the right diagnosis crucial. When the clinical picture fits autonomic dysfunction, targeted testing provides clarity.
What helps:
Research supports starting with lifestyle modifications: increased fluid and salt intake (under medical guidance, the amount varies significantly by individual), strategic exercise reconditioning (often beginning with recumbent activities like swimming or rowing before progressing to upright exercise), and potentially compression garments to reduce blood pooling.
Medications are added when needed, tailored to the patient's specific presentation. Some patients improve significantly over time; others require ongoing management.
The bottom line:
I believe patients deserve two things: to be heard, and to have access to appropriate testing. Not every case of lightheadedness is POTS, and not every POTS patient was misdiagnosed with anxiety. But when symptoms align with autonomic dysfunction, proper evaluation shouldn't take years.
If this sounds familiar: