Ep 84 The Tilt Table-Rita: Inside Netflix's The Crash and the Science of POTS

In this episode, we're shaking up The Tilt Table-Rita — a salty, passion-fruit margarita that doubles as a nod to one of the first-line treatments for our medical topic tonight — and diving into Netflix's buzzy new true crime documentary The Crash (2026). The film revisits the 2022 Strongsville, Ohio case in which 17-year-old Mackenzie Shirilla was convicted of murdering her boyfriend Dominic Russo and his friend Davion Flanagan after driving 100 mph into a brick building, with no evidence of braking. What made this case medically significant — and controversial — was the defense's claim that Shirilla blacked out due to POTS: Postural Orthostatic Tachycardia Syndrome. We break down the real science of POTS — who gets it, how it's diagnosed, the three pathophysiological subtypes, treatment options, and why so many patients are told for years that it's all in their heads. As always, we keep it clinical, honest, and just a little bit fun. Sources: Netflix: The Crash (2026) Netflix Tudum: Where Is Mackenzie Shirilla Now? Bryarly M, et al. Postural Orthostatic Tachycardia Syndrome: JACC Focus Seminar. Journal of the American College of Cardiology. 2019;73(10):1207–1228. Fedorowski A. Postural Orthostatic Tachycardia Syndrome: Clinical Presentation, Aetiology and Management. Journal of Internal Medicine. 2019;285(4):352–366. Sheldon RS, et al. 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of POTS, Inappropriate Sinus Tachycardia, and Vasovagal Syncope. Heart Rhythm. 2015;12(6):e41–63. Vernino S, et al. POTS: State of the Science — 2019 NIH Expert Consensus Meeting, Part 1. Autonomic Neuroscience. 2021;235:102828. Ormiston CK, et al. POTS as a Sequela of COVID-19. Heart Rhythm. 2022;19(11):1880–1889. Boris JR, et al. Long-Term POTS Outcomes Survey. Journal of the American Heart Association. 2024;13(14):e033485. Mar PL, Raj SR. POTS: Mechanisms and New Therapies. Annual Review of Medicine. 2020;71:235–248. Gopinathannair R, et al. Cardiac Arrhythmias and Autonomic Dysfunction Associated With COVID-19. Circulation. 2024;150(21):e449–e465. Episodes every Monday ⭐️ Subscribe, Rate and Review! 🍸 Recipes drop on socials Discounts: 15% off Comfrt apparel Purple Carrot: 40% off your first box ClassPass: 2 weeks free 15% off non-alcoholic spirits at The Zero Proof 💳 Support us on Patreon | ☕️ Buy Me a Coffee Contains affiliate links. We may earn a commission at no additional cost to you.