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Most people hear POTS and immediately look at the heart rate. But in many low preload POTS cases, the heart rate is not the original problem. It is the compensation. The body may be raising heart rate because venous return is poor, blood pools in the legs or abdomen, or the heart is underfilled upright. Before we ask, “How do we lower the heart rate?” ask: “What job is the heart rate doing?” If that heart rate is helping maintain blood flow to the brain, suppressing it without understanding the
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