Does Mackenzie Shirilla Have POTS? The Medical Defense in Netflix’s The Crash Explained
The Crash Netflix: Deconstructing the Strongsville Tragedy
In the theater of high-profile true-crime trials, the battle between cold mechanical metrics and human medical explanations frequently dictates the verdict. For the defense team representing Mackenzie Shirilla during her 2023 bench trial, the primary strategy to counter the state’s 100% throttle black box evidence was a specialized medical defense. Following the global fascination with Netflix’s The Crash, viewers have been fiercely debating the validity of her health claims. The defense argued that Mackenzie did not intentionally drive her car into the Plidco commercial building at 100 mph. Instead, they alleged she was the victim of a sudden, catastrophic medical emergency caused by an underlying condition: Postural Orthostatic Tachycardia Syndrome, commonly known as POTS.
The POTS defense was not merely a footnote in The Crash; it remains the core foundation of Mackenzie’s current 2026 appeals to the Ohio Supreme Court. Understanding why the trial court ultimately rejected this medical explanation requires breaking down the mechanics of the syndrome itself versus the physical evidence left on Progress Drive.
Understanding POTS: The Science of Syncope
To evaluate the legal validity of the defense’s position, it is necessary to first define the pathology of Postural Orthostatic Tachycardia Syndrome. POTS is a form of dysautonomia—a disorder of the autonomic nervous system, which regulates involuntary bodily functions such as heart rate, blood pressure, and digestion.
The defining characteristic of POTS is an abnormal heart rate increase that occurs upon moving from a seated or lying position to an upright posture. When an individual with POTS stands up, gravity pulls blood toward the lower abdomen and extremities. In a healthy body, the autonomic nervous system immediately constricts blood vessels and moderately increases heart rate to maintain steady oxygen flow to the brain. In a POTS patient, this mechanism fails. The body compensates for the pooling blood by releasing excessive amounts of epinephrine and norepinephrine, causing the heart to race wildly—often spiking by more than 30 to 40 beats per minute within moments of standing.
If the heart cannot pump blood efficiently enough to overcome this pooling, the patient experiences cerebral hypoperfusion—a sudden reduction of blood flow to the brain. This results in severe dizziness, tunnel vision, cognitive confusion, and in acute cases, vasovagal syncope (a complete temporary loss of consciousness, or a “blackout”). Mackenzie Shirilla possessed a documented history of a POTS diagnosis dating back to 2017, which her legal team attempted to use as a total shield against criminal intent.
The Defense Theory: A Catastrophic Syncopal Episode
During the trial, and later during her exclusive prison interview in The Crash, Mackenzie maintained that she has absolute amnesia regarding the final moments before the impact. Her defense team structured their narrative around the premise that as she navigated the early morning streets, her dysautonomia triggered an acute, unpredictable syncopal episode.
According to this theory, the sudden blackout caused her body to go limp behind the wheel. The defense argued that her foot did not deliberately stomp on the gas pedal out of malice; rather, during the muscle spasms or limp posture associated with a severe fainting spell, her leg extended, pinning the accelerator to the floorboard mechanically without conscious intent. They asserted that her lack of a braking response was not a sign of cold-blooded murder, but the definitive proof of a driver who was completely unconscious and physically incapable of reacting to the looming brick wall.
To support this claim in the public eye following the documentary’s release, newly unsealed police records revealed text messages from earlier in July 2022. In those messages, Mackenzie complained to Dominic about experiencing severe physical symptoms, explicitly describing an incident on July 2, 2022, as her “worst black out ever.” Her defense attorneys argue that these historical messages prove she was actively suffering from an unstable medical condition in the weeks leading up to the tragedy.
Why the Court Rejected the Medical Defense
Despite the documented medical history, Cuyahoga County Common Pleas Judge Nancy Margaret Russo found the POTS defense completely unconvincing, ultimately rejecting it before delivering a guilty verdict on all murder counts. The prosecution dismantled the blackout theory not by attacking the reality of POTS as a syndrome, but by tracking the physical physics of the vehicle’s trajectory.
The fatal flaw in the defense’s medical argument lay within the steering data and the geometry of Progress Drive. As accident reconstruction experts testified, navigating the road leading to the Plidco building was not a straight shot. The vehicle had to execute a precise right-turn maneuver from Pearl Road onto Progress Drive, followed by navigating a slight left-to-right alignment shift (known as a “dogleg” intersection) at a highly elevated speed.
Medical experts and forensic analysts noted that when a human being undergoes true vasovagal syncope, muscle tone is lost completely. A limp body cannot maintain active, precise steering corrections. Had Mackenzie truly blacked out before the speed reached 100 mph, the vehicle’s tires would have drifted naturally according to the laws of inertia. The Camry would have struck the right-hand curb, veered into the open fields, or hit utility poles long before reaching the end of the commercial corridor.
Instead, the telematics and video evidence showed that the car followed a flawless, aggressive driving line directly down the center of the road before targeting the corner of the brick building. The prosecution successfully argued that it is physically and medically impossible to be completely unconscious while simultaneously performing high-speed, micro-steering adjustments to keep a vehicle perfectly centered on an industrial road.
The 2026 Appellate Battle: Ineffective Assistance of Counsel
The controversy surrounding Mackenzie Shirilla’s POTS diagnosis has reached a boiling point in 2026. Her current appellate attorneys have filed a critical petition with the Ohio Supreme Court, aiming to overturn her life sentence based on how the medical defense was managed during the initial trial.
The core of the 2026 appeal rests on a claim of “Ineffective Assistance of Counsel.” Her new legal team argues that her original trial lawyers failed her fundamentally by only “cursorily referencing” her POTS condition during the trial without presenting any formal, independent medical experts or specialists on dysautonomia to testify on her behalf. The appeal asserts that if the original defense had hired a specialized medical expert to explain the nuances of atypical syncopal episodes—and how adrenaline surges can cause involuntary muscle rigidity—the court might have found reasonable doubt regarding her intent.
However, the Cuyahoga County Prosecutor’s Office remains fiercely dug in, issuing a public statement reaffirming their stance that Mackenzie was on a clear, conscious mission of murder-suicide because she refused to allow Dominic to end their relationship. As the Ohio Supreme Court weighs whether to hear this late-filed petition, the medical defense remains one of the most polarizing aspects of The Crash, leaving true-crime audiences permanently divided over whether Mackenzie was a patient experiencing a medical nightmare or a killer hiding behind a clinical diagnosis.
