UCLA POTS Clinic: A Comprehensive Overview

Postural Orthostatic Tachycardia Syndrome (POTS) is a condition that falls under the umbrella of orthostatic intolerance (OI), where the body struggles to maintain normal blood pressure upon standing. The UCLA POTS Clinic offers specialized care for individuals experiencing this complex disorder. This article delves into the various aspects of POTS, its diagnosis, treatment approaches at UCLA, and the expertise available within the UCLA healthcare system.

Understanding POTS

POTS is characterized by an abnormal increase in heart rate upon standing, often accompanied by a range of debilitating symptoms. In healthy individuals, the autonomic nervous system automatically adjusts heart rate and blood vessel constriction to maintain stable blood pressure when changing positions. However, in individuals with POTS, this system malfunctions, leading to a rapid increase in heart rate, lightheadedness, dizziness, and other symptoms.

The heart muscle is responsible for circulating blood throughout the body. When the heart does not operate as it is supposed to, blood may not pump normally throughout the body.

Types and Causes

POTS can manifest in different forms, each with its underlying mechanisms:

• Partial dysautonomic POTS: This type involves mild damage to the nerves that regulate involuntary bodily functions, such as heartbeat and blood pressure. This damage primarily affects the peripheral blood vessels, impairing their ability to maintain normal blood pressure when the body is upright. Patients appear to have mild damage to nerves that affect involuntary bodily function (peripheral autonomic neuropathy), such as the heartbeat. This damage affects the peripheral blood vessels and their ability to maintain normal blood pressure when there is more stress from gravity, such as when the patient stands up.
• Secondary POTS: In some cases, POTS arises as a consequence of another underlying medical condition, such as diabetes or autoimmune disorders. When this occurs it is known as secondary POTS.

Risk Factors

While POTS can affect individuals of all ages and genders, it is more prevalent among women between the ages of 15 and 50. Some women experience an increase in POTS symptoms right before their menstrual periods. Additionally, individuals with pre-existing conditions associated with secondary POTS may have a higher risk of developing the syndrome.

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Diagnosis at UCLA POTS Clinic

The diagnostic process at the UCLA POTS Clinic typically involves a comprehensive evaluation, including:

• Medical History and Physical Exam: A detailed review of the patient's medical history and a thorough physical examination are essential first steps in identifying potential signs and symptoms of POTS. Diagnosis of POTS will generally begin with the physician taking a medical history and performing a physical exam.
• Tilt Table Study: This test is a crucial diagnostic tool for POTS. It involves monitoring heart rate and blood pressure while the patient is tilted at different angles on a specialized table. This helps assess how the body responds to changes in position and identify any abnormalities in blood pressure regulation. During the physical exam, the physician may perform a tilt table study to evaluate the heart and blood pressure when the body changes positions.
• Additional Tests: In some instances, the physician may order additional tests to rule out other conditions. These diagnostic tests may examine the heart muscle, the blood flow through the heart, and any potential abnormal electrical impulses. These may include an electrocardiogram (ECG) to assess the heart's electrical activity and an echocardiogram to visualize the heart's structure and function. Another diagnostic tool that could be used is an echocardiogram. This noninvasive procedure uses a machine called a transducer that transmits sound waves and bounces them off the heart and back into the transducer.

Treatment Approaches at UCLA

Treatment of POTS will vary for each patient, depending on the type, severity and cause of the condition. The UCLA POTS Clinic offers a multidisciplinary approach to managing POTS, tailoring treatment plans to meet the individual needs of each patient.

• Addressing Underlying Conditions: In cases of secondary POTS, where the syndrome is caused by an underlying condition such as diabetes, treatment focuses on managing the primary condition. In some cases, when POTS is caused by an underlying condition such as diabetes, treatment may focus on managing that underlying condition.
• Physical Therapy: Physical therapy is often a cornerstone of POTS treatment. A gradual reconditioning program, developed in consultation with a physical therapist, helps patients retrain their bodies to function more efficiently. Working with a physical therapist and doing exercises at home as part of a gradual reconditioning program will allow the patient to retrain their body to function more efficiently. Gentle resistance training can work to strengthen the skeletal muscle pump, which helps the heart to circulate blood throughout the body.
• Lifestyle Modifications: Lifestyle changes, such as increasing fluid and salt intake, wearing compression stockings, and avoiding prolonged standing, can help manage POTS symptoms.
• Medications: When physical therapy and lifestyle changes are unable to provide adequate symptom relief, medication may be needed. Medications may be prescribed to help regulate heart rate, blood pressure, and blood volume.

Experts at UCLA

UCLA boasts a team of highly qualified and experienced medical professionals who specialize in the diagnosis and treatment of POTS and related conditions.

• Dr. Hoftman: Dr. Hoftman is an active team member of the California Children's Services (CCS) pediatric rheumatology clinic, as well as the Pediatric Dysautonomia/Postural Orthostatic Tachycardia Syndrome (POTS) Multidisciplinary Clinic. Dr. Hoftman is currently an Assistant Clinical Professor of Pediatrics in the Division of Allergy, Immunology and Rheumatology at UCLA. Dr. Hoftman takes care of pediatric patients under 18 years of age with pediatric rheumatologic diagnoses and concerns, such as evaluation of abnormal serum antibodies, as well as chronic musculoskeletal pain and swelling. Dr. Hoftman's interests lie in the diagnosis and treatment of general pediatric rheumatologic conditions, such as juvenile arthritis, lupus, Sjogren's disease, dermatomyositis, scleroderma, Raynaud's syndrome, vasculitis, periodic fevers, chronic osteomyelitis, uveitis, sarcoidosis, Behcet's, psoriatic arthritis, and inflammatory bowel disease-associated arthropathy. Though she does not specialize in connective tissue disorders such as Ehlers Danlos Syndrome, Dr. Hoftman is familiar with the spectrum of these conditions.
• Neurology Faculty: UCLA's Department of Neurology is committed to ensuring that every patient receives the most accurate diagnosis and optimal treatment. The department includes experts in various neurological subspecialties, including neurogenetics, epilepsy, and neurorehabilitation.
• Dr. Susan Shaw Huang: Dr. Susan Shaw has been the Chair of Neurology at Harbor since 2019. She completed medical school at Northwestern University, where she decided on neurology after watching an intriguing electrocortical stimulation mapping study on an epilepsy patient. She moved to Los Angeles for neurology residency at UCLA, then continued her hopscotch moves around the country to Johns Hopkins for clinical neurophysiology/epilepsy fellowship. After training, she returned to Southern California and began her career at Rancho Los Amigos National Rehabilitation Center, a sister facility to Harbor-UCLA. Her research interests center around neurorehabilitation, neurorestoration and epilepsy, with collaborative projects including brain-computer interface studies, stroke rehabilitation technologies, pharmaceuticals for epilepsy, and artificial intelligence in the epilepsy monitoring unit.
• Dr. Mehta: Dr. Mehta completed his MD from Memorial University of Newfoundland, Canada, Faculty of Medicine. He completed his neurology residency from SUNY Buffalo along with fellowships in Stroke/Cerebrovascular Disease, Multiple Sclerosis, and Neuroimaging. In the area of stroke and cerebrovascular disease he currently studying how vasogenic edema develops post-stroke using neuroimaging as a guide for initiation of potential treatment and prognosis post-stroke. In the area of Multiple Sclerosis and Neuroimmunology, his research interests involve Vitamin A and Vitamin D and its effect on MS disease progression, remyelination, and epigenetic changes in MS patients using clinic and neuroimaging techniques.
• Dr. Margaret Adler: Dr. Adler is a graduate of Emory University School of Medicine. She completed neurology residency at UCLA Medical Center and neuromuscular fellowship at Massachusetts General Hospital and Brigham and Women’s Hospital. She is director of the EMG lab at Harbor and is a core faculty for the neurophysiology fellowship.
• Dr. Edward Chang: Dr. Chang graduated from the Ohio State University College of Medicine and went on to complete neurology residency and Clinical Neurophysiology and Epilepsy fellowships at Ronald Reagan Medical Center-UCLA. He is director of the EEG lab at Harbor-UCLA and the director of the Clinical Neurophysiology fellowship.
• Dr. Kimberly Pargeon: Dr. Pargeon is an Attending Physician in Neurology at Harbor-UCLA Medical Center. Following residency, Dr. Pargeon completed a two-year fellowship in clinical neurophysiology and epilepsy at Columbia University/New York-Presbyterian in New York City in 2011. After her fellowship, she initially joined the neurology faculty at Montefiore Medical Center in The Bronx. She subsequently joined the neurology faculty at The Johns Hopkins Hospital in Baltimore, Maryland, and mostly recently was a member of the neurology faculty at Weill Cornell Medical Center in New York City, where she was the director of the epilepsy monitoring unit and for the training clinics for the neurology residents and fellows. She recently re-located to Los Angeles, California, and has now joined the neurology faculty here at Harbor-UCLA Medical Center. Dr. Pargeon is board certified in Neurology and in Epilepsy.
• Dr. Kronfeld: Dr. Kronfeld completed her Masters degree at Tufts University, followed by her MD at Oregon Health and Science University. She completed her Neurology residency as well as Neurocritical Care and Vascular Neurology Fellowships at Stanford University. She is Director of Inpatient Neurology and Associate Stroke Director at Harbor-UCLA.
• Dr. Neeta Garg: Dr. Neeta Garg, MD, Health Sciences Clinical Professor. Dr. Neeta Garg is a Health Sciences Clinical Professor of Neurology at UCLA David Geffen School of Medicine. Dr. Garg obtained her MD degree from SMS Medical College, Jaipur, India, did an Internship and Neurology residency in India and a second Neurology residency at Seton Hall/JFK Medical Center. Dr. Garg was an Assistant Professor at SUNY Buffalo, and then an Assistant and Associate Professor at University of Massachusetts. She was then an Associate and full Professor at University of Miami. Dr. Garg has been very active in the American Academy of Neurology, serving on the Neurology Education Committee, Axon Registry Subcommittee, MS Section, and several important workgroups overseeing MS quality measure development, drug approval policy guidance, efforts to optimize registry race and ethnicity data collection, and telehealth visit template creation. Dr. Garg has a tremendous record of committee and administrative service at UMass and University of Miami (UM), serving (among many other elements) on the medical student admissions committee, faculty and leadership search committee, UM medical school faculty council and UM faculty senate. Dr. Garg has extensive background in quality improvement (QI) leading several QI projects and initiatives at UM. She has been involved in many curricular development activities for residency program and medical school at UM in her role as course co-director for pre-clinical neurology and QI curricula. Dr. Garg has been site PI on numerous clinical trials in the MS field.
• Dr. Wong: Dr. Wong graduated from the McGovern Medical School at UTHealth in Houston, with a scholarly concentration in Medical Humanities. She went on to complete neurology residency at USC and fellowships in neurorehabilitation at UCLA and neurobehavior at USC. She now provides neurobehavior care for county patients at Harbor-UCLA, Rancho Los Amigos National Rehabilitation Center, and LAC+USC.
• Dr. Johnson-Black: Dr. Johnson-Black’s BioDepartment of NeurologyDr. Johnson-Black is a board-certified neurologist and neurointensivist. Dr. Johnson-Black earned her medical degree from the University of California, San Francisco School of Medicine and completed an internal medicine internship at Olive View-UCLA Medical Center. She completed Neurology residency and Neurocritical Care fellowship at UCLA Medical Center. She is Associate Program Director for the Neurology residency at Harbor-UCLA. Her interests include prognostication in severe neurologic injury, secondary brain injury after TBI, and medical education.
• Dr. Agnes Chen: Dr. Agnes Chen is a graduate of Boston University School of Medicine. Prior to medical school, she was a transcranial doppler technician at the Massachusetts General Hospital. She completed her pediatric residency and adult and child neurology residency at Harbor-UCLA Medical Center. During residency, she began doing research in neurogenetics, specifically lysosomal storage disorders. She is the principal investigator of a clinical trial of intrathecal enzyme replacement in attenuated mucopolysaccharidosis type I.
• Dr. Megan Langille: Dr. Megan Langille is from Long Island, NY. She completed her medical degree at University of Southern California, pediatric residency training at Harbor UCLA and child neurology fellowship at Children’s Hospital Los Angeles. She developed an interest in autoimmune conditions of the central nervous system and was awarded a clinical fellowship from the National MS Society which she completed at USC MS Center.
• Dr. Kenneth Huff: Dr. Kenneth Huff is a graduate of Johns Hopkins Medical School, where he also did his pediatric residency. He then completed residency in neurology at Children’s Hospital in Boston and he completely fellowships in neurological chemistry and neurological pathology.
• Dr. Michelle Armacost: Dr. Michelle Armacost was born and raised in Santa Monica, CA. She attended UCLA where she majored in French and Linguistics. After deciding to pursue a career in medicine, she attended the Post-Baccalaureate Premedical Program at Johns Hopkins University. She attended medical school at USC and stayed on to complete Neurology residency and Epilepsy fellowship there. Following her graduation from fellowship, she joined her mentors Dr. Susan Shaw and Dr. Tory Gong at Rancho Los Amigos National Rehabilitation Center as a full-time neurologist and epileptologist. She currently serves as the Director of the Acute Neurology Unit and cares for patients both in the outpatient and inpatient settings, including patients admitted to the Epilepsy Monitoring Unit. She is board certified in both Neurology and Epilepsy, and her interests include the medical and surgical management of patients with intractable epilepsy.
• Dr. Antonio Moya: Dr. Antonio Moya is a Board Certified Neurologist, Assistant Professor of Neurology at the Keck School of Medicine of USC, and cares for patients at Rancho Los Amigos National Rehabilitation Center as well as High Desert Regional Health Center. Antonio co-founded the Council of Young Filipino Americans in Medicine (CYFAM) in 2019. He completed his neurology residency at New York-Presbyterian Weill Cornell Medical Center and the Memorial Sloan Kettering Cancer Center. Dr. Moya was awarded a Fulbright Fellowship in the Philippines before medical school, specifically working on establishing telemedicine stroke care in this archipelago nation of more than 7,000 islands.
• Dr. Hui (Tory) Gong: Dr. Hui (Tory) Gong obtained her Medical Degree from Hunan Medical University’s western medicine program partnered with the Yale-China Association, which is closely affiliated with the Yale University School of Medicine. She then enhanced her medical knowledge with medical student clinical clerkship training from New York Medical College before joining the medicine and neurology residencies at University of New Mexico. She completed her Clinical Neurophysiology and Epilepsy fellowships in Keck School of Medicine of the University of Southern California (Keck-USC). She is currently an attending physician specialist in neurology and Director of Epilepsy Monitoring Unit (EMU) in the department of neurology at Rancho Los Amigos National Rehabilitation Center. She is also an adjunct assistant professor at the department of neurology at Keck-USC. Dr. Gong is triple board certified in Neurology, Clinical Neurophysiology and Epilepsy by the American Board of Psychiatry and Neurology. Her primary focus in clinical practice is improving patient’s epilepsy care with expertise in the medical and surgical management of refractory epilepsy. She utilizes an innovative approach with personalized medication programs combined with, localized surgery options and neuromodulation such as vagus nerve stimulation for epilepsy patients. She is the Director of Rancho EMU, which has been awarded level 4 center certification from National Association of Epilepsy Centers. Currently, Dr. Gong’s research focuses on pathophysiology of epilepsy and study of status epilepticus. She received the Young Investigator Award from American Epilepsy Society for her work on refractory epilepsy in Infants with Non-accidental Head Injury. Her research interests include the development of new anti-epileptic drugs (AED); she is the Principal Investigator of clinical trials of new AEDs. She has a keen interest in neuromodulation intervention for epilepsy patients, as well as, stroke and rehabilitation patients. She is the co-investigator in the safety and efficacy of the stem cell transplantation in cervical spinal cord injury as well as numerous brain computer interface projects which including encoding arm movement, gait and memory. She has 16 publications on epilepsy, sleep, peripheral neuropathy and brain computer interface.
• Dr. Maluste: Dr. Maluste completed his Neurology residency and a Vascular Neurology fellowship at UCLA. He subsequently spent 6 years with Southland Neurologic Institute in Long Beach before transitioning to the Tibor Rubin Long Beach VA Medical Center as a staff Neurologist in 2023. He currently serves as the Stroke Program Director for Lakewood Regional Medical Center and is also on staff with the VA’s National Telestroke Program. In his free time, Dr.
• Dr. Kristy Hwang: Dr. Hwang completed medical school at the Oakland University William Beaumont School of Medicine in Michigan. She completed neurology residency at Emory University in Atlanta, Georgia, followed by a two-year movement disorder fellowship at the University of California, San Diego. She sees patients with movement disorders and cognitive impairment at the Long Beach VA. She has a research interest in imaging biomarkers for cognitive impairment in movement disorders.
• Dr. Melamed: Dr. Melamed earned her medical degree from SUNY Downstate College of Medicine. She completed her neurology residency at Montefiore Medical Center/Albert Einstein College of Medicine, followed by a fellowship in multiple sclerosis/neuroimmunology at Beth Israel Deaconess Medical Center. She has special interest in misdiagnosis of multiple sclerosis as well as headache medicine.
• Dr. Craig Alex German: Dr. Craig Alex German is a neurologist in Mission Hills, CA specializing in neurology (brain & spinal cord disease). He graduated from Rosalind Franklin University of Medicine and Science, Chicago Medical School.
• Dr. Demi Tran: Dr. Demi Tran earned her medical degree at New York Medical College. She completed a neurology residency at UCI Medical Center in California, followed by a fellowship in clinical neurophysiology with an emphasis in epilepsy at UCI Medical Center.
• Dr. Annabel Wang: Dr.
• Dr. An Tran: Dr.
• Dr. Mark Fisher: Dr. Mark Fisher was Chair of the UCI Department of Neurology from 1998-2006, during which time the Department of Neurology entered the Top 10 in NIH Research Funding for neurology departments nationwide.
• Dr. Michael Sy: Dr.
• Dr. Gaby Thai: Dr.
• Dr. Rahila Ansari: Dr. Rahila Ansari is the new chief of Neurology at the Long Beach VA. Dr. Ansari is dedicated to translating engineering solutions into the clinical setting to help restore function to patients with neurological deficits. After graduate school in biomedical and …

Research and Innovation

UCLA is a leading center for research on POTS and other neurological disorders. The UCLA Neurogenetics Clinic, directed by Dr. Fogel, utilizes state-of-the-art technologies including clinical exome sequencing to diagnose rare neurological disorders. The UCLA Ataxia Center, directed by Dr. Perlman, is one of the first nationally recognized ataxia programs and the largest in the western United States. Effort to achieve this include the Clinical Neurogenomics Research Center, directed by Dr. Fogel. The CNRC links patients with neurological disease to the system-wide efforts of the UCLA Institute of Precision Health, directed by Dr. Geschwind. The CNRC includes efforts to collect and store biological samples for research to bring genomic diagnostic and research advances to every patient with neurological disease. We see patients with a wide variety of genetic conditions, including Friedreich Ataxia, all types of Spinocerebellar Ataxia, Huntington’s disease, Adrenoleukodystrophy, and Frontotemporal Dementia. Clinicians and researchers at UCLA are routinely involved in both national and international research collaborations involving translational research and clinical trials involving a wide variety of neurogenetic disorders. There are typically more than a dozen such trials ongoing at any one time. Researchers in the Neurogenetics Program are also working to identify new genes which cause both rare and common neurologic diseases using cutting-edge genomic technologies including exome and genome sequencing. The work within the program is funded by multiple grants from the National Institutes of Health and several private foundations.

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