Ep 166. Understanding POTS. Insights from Dr. Jeffrey Boris Part 1

Pediatric cardiologist Dr. Jeffrey Boris outlines what POTS is, how it’s defined historically and clinically, and why diagnosis is often delayed or missed. He reviews hallmark symptoms (orthostatic tachycardia, lightheadedness, presyncope/syncope, fatigue, brain fog, exercise intolerance, GI complaints) and common triggers such as illness, injury, surgery, growth/puberty, and stress. The discussion emphasizes objective orthostatic vitals/active stand or tilt testing and the need to rule out mimics, while recognizing frequent overlap with conditions like fibromyalgia and other chronic pain syndromes. Management is individualized and multimodal: high fluids and salt, compression, pacing and graded reconditioning, sleep and pain strategies, and, when needed, medications such as volume expanders, heart-rate–lowering agents, and vasoconstrictors. Dr. Boris highlights the heterogeneity of POTS phenotypes, the importance of validating patients’ experiences, and the substantial need for better research funding and rigorous studies to refine mechanisms and treatments.