Our firm handles a number of cases for people who have sustained some serious, but less frequently experienced neurological injuries after traumatic injuries. This can include neurodegenerative conditions caused or aggravated by trauma (or the treatments for trauma), such as Chronic Traumatic Encephalopathy (“CTE”), Myasthenia Gravis, and others. One devastating neurological condition we have experience handling (including trials) is Postural Orthostatic Tachycardia Syndrome or “POTS.”
Postural Orthostatic Tachycardia Syndrome (“POTS”)
Postural Orthostatic Tachycardia Syndrome or “POTS” is a condition of the autonomic nervous system that impacts the body’s ability to control blood flow in the brain and body. It can be caused by a traumatic injury, particularly traumatic brain injuries and injuries to the brain stem or upper neck.
The condition can be best explained by taking the term apart.
First of all, “Posture” means that the injured person’s blood vessel function is dependent upon whether she is lying down, sitting up or standing up. When someone sustains this kind of injury, their blood vessels don’t react correctly to changes in position.
Second – “Orthostatic.” That just means a change in position. In this case from lying to sitting or from lying to standing.
Tachycardia – That means that your heart is beating too fast.
Syndrome – This means that you have a number of symptoms that result from the condition.
When you put all of these words together, what this means is that because of damage to the autonomic nervous system caused by the injury, the person’s heart and blood vessels don’t work right. The doctors who understand these conditions refer to this as a “Dysautonomia.” The medical literature supports that dysautonomia's can be caused by mild traumatic brain injury, moderate traumatic brain injury or severe traumatic brain injury (which are diagnostically only differentiated by the duration of loss of consciousness (from no loss of consciousness to coma.)
Normally when we lie down, 40% of our blood is in our middle section called our thorax. Blood vessels are like a series of hoses, and they are filled with liquid which is blood. Think about what happens when you take something with fluid in it, like a bottle and you stand it upright. All the liquid flows to the bottom. Well, if that happened in humans, we would pass out because all of the blood would come out of our brain. So, normally what happens is that our autonomic nervous system senses this movement through the brain stem, and it sends out a signal to the blood vessels to contract or narrow the tubes, which increases the pressure within the blood vessels, and keeps the blood flowing to the brain. A normal person’s heart rate might go up by 10 beats per minute or less when we go from laying to sitting or standing.
In a person with POTS, this does not happen. Because of the injury to the brain stem or Autonomic Nervous System, it doesn’t send out a correct signal, and the blood vessels do not contract. Instead, blood goes down into the legs and the person’s legs get discolored. They get lightheaded, and their heart starts to beat very fast. The only way that the blood can be pumped to the brain is for the heart to work that much harder.
Heart palpitations and a rapid heartbeat are scary. Not just from a thinking standpoint, but your body is programmed to sense there is a life threatening crisis because you have both a very rapid heartbeat and too little blood in the brain. The body is programmed to react in a major way, so that you will make a change to relieve the situation. But, people with POTS can’t do that. They are trapped. Every time they sit up or stand up, their heart and brain send the emergency signals.
People with Postural Orthostatic Tachycardia Syndrome can experience the following symptoms:
- Dizziness / balance problems
- Heart Palpitations
- Increased symptoms in the heat. They may feel sick in the sun, so they may avoid the sun.
- A sense of weakness
- Shortness of breath
- Chest pain
- Very rapid heart beat when rising
- Nauseous when they sit up or stand up
- Unexpected, and uncontrollable vomiting
- Exacerbated by eating meals (sometimes vomiting afterwards)
- Abdominal pain
- Exercise Intolerance
- Salt restriction can make them feel worse
- Medications don’t help
- Legs turn purple when standing (particularly in shower) - signaling blood pooling
- Abnormal sweating and coldness in hands to the point they turn white like poor circulation
- Problem with holding hands up.
- The person’s face may have a white / red pattern to it that they didn’t have before.
- Sometimes they will cry uncontrollably.
It is not unusual for doctors (particularly those working for the insurance company) to believe these patients have a psychological problem or a personality disorder that is resulting in unexplained or unrelated symptoms. Few doctors know much about POTS or other autonomic nervous system dysfunction, and their dismissal of these symptoms to a personality disorder is more a sign of their ignorance, than a sign of the patient faking an injury. This is an awful condition and will change the course of one’s life. Many people with POTS lead a very different kind of life than they did before having the condition.
A well known personality test called the Minnesota Multiphasic Personality Inventory ("MMPI-2") shows what appear to be abnormal elevations on the MMPI scale scores due to certain conditions such as neurological injuries, cardiac problems, gastointestinal problems or respiratory problems. POTS will trigger all of these as the condition impacts the nervous system, heart, blood vessels and gastrointestinal system. Rather than acknowledging this, the insurance company doctors will say that you are hysterical, or are malingering (lying about your conditions) based upon the "Fake Bad Scale" of the MMPI. If you have an injury claim that involves POTS, it is critical that you have a lawyer who has substantial experience handling brain injury claims or even better one with specific experience in Postural Orthostatic Tachycardia Syndrome cases. Our office has that experience.
The medical literature supports that Postural Orthostatic Tachycardia Syndrome can be caused by a traumatic brain injury, or an injury to the brain stem.
There are times when POTS can also be caused by an instability of the upper neck caused by trauma, which can put abnormal pressure on the brain stem, the vertebral arteries and as a result the circulation into the brain. This could be an area of investigation for those suffering from POTS because if this is the causative factor it needs to be reviewed by a doctor to see if it coud be reversed. It may require a stabilization surgery of the upper neck, but for people suffering from the consequences of POTS, the potential benefit of the surgery may be worth the risk.
If you have experienced signs of POTS see a neurologist or cardiologist and ask for a “tilt table test.” Do research on doctors in your area to find one who knows about POTS before you make an appointment.
If you have a claim for an injury that caused POTS, you need a Postural Orthostatic Tachycardia Syndrome lawyer. Our firm has a library of research on the connection between Postural Orthostatic Tachycardia Syndrome and trauma. Call (503) 227-1233 to schedule your free consultation today.