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Disability Benefits for POTS (Postural Orthostatic Tachycardia Syndrome)

ERISA & Social Security Disability: Southern California Lawyers

Disability Benefits for POTS (Postural Orthostatic Tachycardia Syndrome)

The National Institutes of Health describe Postural Orthostatic Tachycardia Syndrome (POTS) as one of a group of disorders that have orthostatic intolerance (OI) as their primary symptom. OI describes a condition in which an excessively reduced volume of blood returns to the heart after an individual stands up from a lying down position. The primary symptom of OI is lightheadedness or fainting. In POTS, the lightheadedness or fainting is also accompanied by a rapid increase in heartbeat of more than 30 beats per minute, or a heart rate that exceeds 120 beats per minute, within 10 minutes of rising. The faintness or lightheadedness of POTS are relieved by lying down again. Anyone at any age can develop POTS, but most individuals affected (up to 80 %) are women between the ages of 15 to 50 years of age. Some women report an increase in episodes of POTS right before their menstrual periods.

POTS often begins after a pregnancy, major surgery, trauma, or a viral illness. It may make individuals unable to exercise because the activity brings on fainting spells or dizziness.

Doctors aren't sure yet what causes the reduced return of blood to the heart that occurs in OI, or why the heart begins to beat so rapidly in POTS. Current thinking is that there are several mechanisms. Some individuals have peripheral denervation (neuropathic POTS); some have symptoms that are due to sustained or parosyxmal overactivity of the sympathetic nervous system (hyperadrenergic POTS); and many individuals with POTS have significant deconditioning.


Symptoms of POTS

POTS can cause symptoms that may be mild or severe, including light-headedness, fatigue, sweating, tremor, palpitations, exercise intolerance, near syncope, recurrent syncope (fainting) when standing upright, mental clouding (“brain fog”), blurred vision, shortness of breath, early satiety (feeling of fullness), nausea, headache, chest pain, anxiety, flushing, low blood pressure (hypotension), especially after eating, back, neck, and shoulder pains, cold hands, feet, and nose. Worsening of symptoms may be brought on by eating, showering, or even mild exertion.

In refractory and severe cases, treatment may not help much, and there may be a high degree of disability.

[Reference: Abed H, Ball P, and Wang LX. “Diagnosis and management of postural orthostatic tachycardia syndrome: A brief review.” J Geriatr Cardiol. 2012 Mar; 9(1): 61–67.]

Treatment for POTS

Treatment for POTS includes adding extra salt to the diet and keeping well-hydrated. Medications, such as fludrocortisone or midodrine, can help the symptoms of POTS by increasing the blood volume and narrowing the blood vessels. Ivabradine (a sinus node blocker) and beta blockers, like propranolol, may help some patients. Erythropoietin increases blood pressure in patients with POTS by constricting the blood vessels and increasing the number of red blood cells in the circulation. Pyridostigmine bromide, ergotamine, octreotide, ephedrine, pseudoephedrine, yohimbine, theophylline, methylphenidate methyldopa, non-steroidal anti-inflammatory drugs (NSAIDs, such as indomethacin), and some anti-depressants have all been used from time to time, with varied success. Id.

Objective Tests for POTS

In addition to a patient's self-report of symptoms associated with POTS, there are some objective tests that help to confirm the diagnosis.

In a patient with POTS, the heart rate typically increases by 30 beats per minute or more, within 10 minutes of standing or head-up tilt on a tilt-table. A patient's standing heart rate often is 120 beats per minute or more, within 10 minutes of standing or head-up tilt. [Reference: Kavi L. Am Fam Physician. 2012 Sep 1;86(5):392-394.]

These are objective abnormalities on physical examination that help confirm the diagnosis of POTS and that should be carefully documented by a treating physician.

Patients with POTS have tachycardia (rapid heart rate) that originates from the sinus node, which may be documented on an electrocardiogram (EKG), echocardiogram, or Holter monitor. A Valsalva maneuver often produces a vigorous pressor response, and an exaggerated blood pressure fall, recovery and overshoot, may be seen and should be documented by the doctor.

There are some laboratory tests that can be performed, including an upright plasma norepinephrine (after at least 5-10 minutes of standing or tilting) level, which is frequently elevated (>600 pg/ml) in POTS patients, reflecting the exaggerated neural sympathetic tone that is often present in these patients.

Documenting your limitations:  How does your condition affect you? Be specific to articulate to your physician details of your physical limitations and how they impact you on a daily basis with regard to your daily living activities, your ability to stand/walk, lift/carry, and even sit for extended periods of time and need for breaks or rest from pain or fatigue. These are important factors and details regarding your functional capacity and important in evaluating whether you can perform your work or any work.

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