Mismanagement of Postural Orthostatic Tachycardia Syndrome (POTS)

Imagine how frustrating it would be to experience distressing, unpredictable symptoms like dizziness and fainting, rapid heartbeat, crushing fatigue, and migraines. Now imagine that you go to your doctor for help, only to be told that there’s nothing wrong with you and your symptoms are “all in your head.” Unfortunately, that experience is all too common for sufferers of Postural Orthostatic Tachycardia Syndrome, or POTS. What exactly is POTS, and when is failure to diagnose and treat it medical malpractice?

What is Postural Orthostatic Tachycardia Syndrome?

POTS is a condition that affects blood flow in the body based on the body’s position (posture). When most people change position, say from sitting to standing, gravity pulls the blood in their body down toward the legs. However, the body’s autonomic nervous system (ANS) helps the body quickly adjust, sending blood back up to the brain while keeping the heart rate pretty much steady. (The ANS controls the body’s automatic functions, like digestion and heart rate).

When someone has POTS, the ANS doesn’t function properly. As a result, the body has to overcompensate: the heart beats very fast to try to pump blood back up toward the brain. That can lead to dizziness, fainting, and a variety of other symptoms that include:

• Brain fog, confusion, blurred vision, lightheadedness
• Sleep disturbances
• Anxiety, depression
• Increased heart rate, heart palpitations
• Chest pain or discomfort
• High blood pressure (or low blood pressure)
• Gastrointestinal symptoms such as diarrhea or constipation, nausea, bloating, cramping
• Increased urination or difficulty urinating
• Increased or decreased sweating
• Fatigue or weakness
• Shortness of breath
• Edema or discoloration of extremities
• Poor temperature regulation

Not everyone with POTS experiences all of these symptoms, or experiences symptoms all the time. When they are present, of course, they can seriously disrupt the sufferer’s life.

Who Suffers from POTS?

POTS is uncommon, but it’s not rare: An estimated 1-3 million people from the United States suffer from POTS. The great majority of those people—80-90%—are girls and women between the ages of 15 and 50. However, POTS can affect men, too.

It’s not totally clear why some people get POTS. Symptoms may appear after a physical stressor, like pregnancy, surgery, or an accident. Viral infections, like COVID-19, can also cause POTS, perhaps by impacting the autonomic nervous system or by triggering an autoimmune response. For some people, POTS or POTS-like symptoms appear as a “long COVID” response. Unfortunately, for a variety of reasons, POTS can be difficult to diagnose, leading to frustration and ongoing suffering for those afflicted with the syndrome.

Why is POTS so Hard to Diagnose?

There are a variety of reasons that people with postural orthostatic tachycardia syndrome struggle to get an answer about what’s going on with them:

• Symptoms vary between POTS patients, and even with a single patient from day to day or even hour to hour.
• Although the syndrome is becoming more common in the wake of COVID, it is still relatively uncommon and therefore often underrecognized by doctors.
• Symptoms of POTS, like dizziness, rapid heartbeat, and fatigue, are also present in many other, more common conditions, including heart or endocrine disorders or anxiety.
• Because the syndrome is vastly more common in women, some doctors may be more likely to chalk symptoms up to anxiety or panic disorders.
• POTS symptoms may not always be observable in healthcare settings, and routine testing like blood panels and EKGs often return normal results.
• Some people experience POTS symptoms only under specific circumstances, like being on their feet for a long time.
• Many people with POTS have other conditions like autoimmune disorders, whose symptoms may complicate the diagnosis of postural orthostatic tachycardia syndrome.

Unfortunately, if POTS is not diagnosed and treated, many complications can ensue, including chronic fatigue, reduced physical function, cognitive impairment, strain on the cardiovascular system, and overall diminished quality of life.

Diagnosis and Treatment of Postural Orthostatic Tachycardia Syndrome

When a patient presents with symptoms of POTS, doctors should begin by getting a thorough medical history and performing a physical. After that, it makes sense to order blood tests and an EKG just to rule out other possible causes of reported symptoms. Because POTS symptoms come and go, a doctor may decide to have the patient wear a device called a Holter monitor to measure their heart rate and blood pressure over the course of several days. But the standard diagnostic test for POTS is a tilt table test.

In a tilt table test, the patient lies on a flat table that tilts vertically, while their blood pressure and heart rate are monitored. Postural orthostatic tachycardia syndrome is often confirmed when a patient’s heart rate increases more than 30 beats per minute within 10 minutes of standing (an increase of 10 beats per minute is normal). The significantly increased heart rate is usually not accompanied by a significant drop in blood pressure.

Being diagnosed with POTS is a relief for most people, especially those who have had to advocate for themselves with medical personnel who did not believe that they had a “real” condition. Though there is no cure for POTS, a diagnosis allows sufferers to manage symptoms through a combination of lifestyle changes (like increased salt and water intake and compression garments), medicine (including beta-blockers, steroids, and vasoconstrictors), physical therapy, and management of co-existing conditions.

Postural Orthostatic Tachycardia Syndrome Malpractice

Can you sue for POTS malpractice if your doctor failed to diagnose and treat your condition? These lawsuits are challenging, since they hinge in part on what a reasonable doctor in similar circumstances would have done.

However, if you have been experiencing POTS symptoms, and your care providers have repeatedly failed to perform a tilt table test, your symptoms may have gotten worse or become permanent. If that’s the case, you may have a claim for malpractice, and you should talk to an experienced medical malpractice attorney to review your options. To learn more about postural orthostatic tachycardia syndrome and POTS malpractice, contact the Fraser Firm to schedule a consultation to discuss your situation.