She Was Told It Was Panic for Four Years. It Was POTS.

The notebook began in September 2018, during her first semester of college. It was an ordinary notebook meant for class assignments, but after she nearly fainted while waiting for lunch, she turned to an empty page and wrote down what she could remember: standing in line, sudden heat, blurred vision, heart racing, sitting on the floor.

She was eighteen. The campus clinic checked her blood pressure while she sat, asked about sleep and meals, and told her the episode was probably related to stress. College was an adjustment. She had been anxious before exams.

Both statements were true, and neither explained why walking across campus had started to feel like sustained exertion or why standing through a lab left her shaking.

The notebook stayed in her backpack.

Over the next five months, she added entries after episodes. Some were brief: “Shower, dizzy, had to sit.” Others included numbers from the fitness watch her parents had given her, such as a pulse in the seventies while seated and above 120 after she stood. She did not yet know whether the numbers mattered.

She recorded them because they were among the few parts of the experience that did not depend on finding the right words.

By February 2019, she was skipping breakfast less often, sleeping longer, and carrying water, changes suggested by people who believed the problem came from college habits. The symptoms continued. Brain fog arrived in lectures as an inability to hold onto the previous sentence, even when she had read the material the night before, and her notes began to contain gaps where she had stopped processing what the professor was saying.

A primary care doctor ordered routine blood work and a heart tracing. The results did not show an explanation. “Your tests are reassuring,” the doctor said. The portal note from that visit described palpitations and anxiety.

Anxiety became the durable part of the record.

The panic explanation

In April 2019, she went to the emergency department after her heart began racing while she stood at a campus event. She felt faint, lowered herself to the ground, and remained conscious. By the time she was assessed lying down, the worst of the episode had passed. Another heart tracing was read as normal, and the discharge paperwork referred to a panic attack.

She opened the notebook in the car afterward. The entry occupied half a page: standing for about twenty minutes, pulse rising, vision narrowing, no frightening thought before the symptoms. She underlined the final point because clinicians kept asking what she had been worried about when the episode began.

The distinction mattered to her. Panic, as she had experienced it in high school, began with fear and could happen while she was seated. These episodes followed standing, walking, showers, or waiting in line. Fear came later, after her body had become difficult to control and she had started calculating how far she was from a place to sit.

Still, “This sounds like panic” was repeated at appointments through the next academic year. One doctor suggested counseling. She went for seven months and found it useful for the dread that had accumulated around class attendance, but the therapist also noticed that the physical episodes followed posture and exertion rather than an anxious thought. That observation did not alter the medical record.

By December 2019, the notebook contained thirty-eight dated episodes. A doctor flipped through several pages, then set it beside the exam table without discussing the pulse readings. He ordered another round of blood work and suggested reducing stress.

She stopped bringing the notebook for a while.

The practical losses were small enough to be explained one at a time. She withdrew from a lab that required long periods of standing. She avoided dining hall lines and began eating food she could keep in her room. Friends learned that an invitation involving a walk might be declined at the last minute, while instructors saw absences and late work without seeing the preparation required to cross campus on a bad day.

In March 2020, classes moved online. Her symptoms did not disappear, but the distance between bed and lecture became a few steps, and she could listen while lying down when sitting upright became difficult. Her grades improved that spring. To one doctor, that improvement supported anxiety as the explanation.

To her, it showed that removing prolonged standing had changed what she could do.

What the record missed

For fourteen months, she had few in-person appointments. She continued to experience episodes at home, including one in August 2020 when she stood at the kitchen counter, lost her hearing briefly, and lowered herself to the floor. Her mother retrieved the notebook from a drawer. Together they began recording seated and standing pulse readings again, along with symptoms and how long she had been upright.

The notebook was not a clinical test. It was uneven, with missing weeks and entries written after the fact, but it preserved a pattern that short appointments repeatedly lost: her pulse changed with posture, the faintness eased when she lay down, and the episodes occurred even during months when she did not feel persistently anxious.

A cardiology referral in January 2021 led to heart monitoring and an ultrasound. The bill after insurance was $612. The testing did not identify a structural heart problem or a dangerous rhythm, which was important, but the follow-up message again emphasized reassuring results without explaining why standing remained so difficult.

She paid the $612 in installments. The notebook went back into her backpack beside the bill.

That summer, she started a part-time job that could mostly be done seated. On shifts that required more standing, she became nauseated and struggled to follow conversations. A supervisor allowed her to use a stool after she disclosed that she was being evaluated for episodes of rapid heart rate and faintness. She did not have a name for the condition, and the lack of one made every explanation sound provisional.

The first mention of postural orthostatic tachycardia syndrome came from another patient’s public account in late 2021. The description was recognizable, particularly the connection between upright posture, increased heart rate, fatigue, and cognitive difficulty. She did not treat the account as an answer. She wrote “POTS” near the back of the notebook and brought it to her next primary care visit.

The doctor said the condition was uncommon and that anxiety could also raise heart rate. She asked whether anyone had measured her pulse continuously from lying down through standing. The record showed seated vital signs from many visits and lying measurements from the emergency department. It did not show a sustained standing assessment.

A referral to a specialist was placed in February 2022. The first available appointment was eight months away.

The measurement that changed the chart

At the October 2022 appointment, the specialist read the notebook before examining her. He did not accept every watch reading as precise, but he treated the repeated relationship to standing as evidence worth testing. During a monitored standing assessment, her pulse rose from 78 while resting to 132 while upright, and familiar symptoms developed: lightheadedness, shaking, blurred vision, and difficulty answering a question.

Her blood pressure findings did not account for the change. The specialist reviewed her previous heart testing, symptom history, and medication list, then told her that the pattern met the criteria for postural orthostatic tachycardia syndrome, or POTS, after other explanations considered in her workup had not been found.

POTS affects the autonomic processes involved in circulation when a person is upright. Tachycardia is part of its name, but the condition can also involve fatigue, faintness, exercise intolerance, nausea, and cognitive problems commonly described as brain fog. Symptoms overlap with anxiety, and a racing heart can produce fear, yet overlap does not establish that anxiety caused her episodes.

The diagnosis did not erase anxiety from her chart. A later visit summary still listed it near the top, above POTS, because older entries remained attached to her history. What changed was the interpretation of the same events. The racing heart in a line, the difficulty in the shower, and the improvement during remote classes could now be read together rather than as separate failures to tolerate stress.

Her specialist outlined a treatment plan and scheduled follow-up. Her college approved flexible attendance and a seating accommodation based on the documented condition, which meant she no longer had to negotiate separately with each instructor. Medication and other measures reduced some episodes over the next year, although fatigue and brain fog continued to determine how much she could do.

There was no clean return to the life she had expected at eighteen. She finished college one semester later than planned and chose work that could be done from home. Some mornings she could shower and make breakfast before opening her laptop. On others, she sat on the bathroom floor until the faintness passed.

In November 2023, five years after the first entry, she opened the notebook while preparing for a follow-up appointment. The early pages still contained the words “probably stress,” copied from what she had been told. Beneath them were the numbers she had once recorded without knowing whether anyone would use them.

Questions people ask

Why can POTS be mistaken for panic attacks?

Both can involve a racing heart, shaking, breathlessness, and fear. In this story, clinicians focused on anxiety while missing that the episodes repeatedly followed standing and eased when she lay down. Normal results from tests for other heart problems also reinforced the panic explanation without accounting for the postural pattern.

What changed when someone measured her pulse while standing?

Earlier visits often captured her vital signs while she was seated or lying down, after the worst symptoms had passed. The specialist observed a sustained pulse increase and familiar symptoms during a monitored standing assessment, then considered those findings alongside four years of records and previous testing.

Did normal heart tests rule out POTS for her?

No. Her heart tracing, monitoring, and ultrasound did not reveal the explanation clinicians were looking for, but those results did not document how her circulation responded to being upright. They helped the specialist consider other causes while the standing assessment addressed the pattern recorded in her notebook.

Did getting a diagnosis end the disruption?

The diagnosis changed her medical record and helped her obtain college accommodations, but it did not restore all of her stamina or remove older anxiety labels. She finished school later than planned, chose remote work, and kept tracking difficult periods. The notebook remained in her backpack for follow-up visits.