Postural orthostatic tachycardia

Heading181

New Member
Hello,

I am getting ready to take my 1st class medical and I’m worried I may be denied before I even begin my training. Over the last year or so, I have noticed that I have been getting this light headedness upon standing. I have noticed this has specifically been happening while eating lower calories and seems to be made worse after exercise or drinking alcohol. It should be noted that I have never passed out or even felt close to passing out, just at times felt like I stood up too quickly. For the longest time, I thought this was normal until I started looking it up in preparation for my medical. In the last year, I visited my GP because I seemed to have a low HR (usually in the low 50’s, sometimes in the 40’s) I had an EKG done and was told everything is normal. I am fearful this may be a condition called POTS (Postural orthostatic tachycardia syndrome.) I have an appointment with my GP coming up to discuss. My question is, if this is POTS, is it even possible to obtain a 1st class?
I appreciate your time.
 

FlightSurgeon

Well-Known Member
Hi Heading181,

You may be getting a little ahead of yourself. I would avoid the inclination to self diagnose. Also, when you have interactions with medical professionals you should remind them that you are pursuing FAA certification and ask them to avoid using generalized or "wastebasket" diagnoses on the chart. I'll answer your question first. If you are diagnosed with POTS you will be required to prove to the FAA that you are not at risk for a cardiac event, which could involve stress testing, holter monitoring, and evaluation by a cardiologist. You would probably be given a special issuance certificate if everything checks out.

I don't intend to treat you over the internet, but you've already said that you have a low heartrate with a good EKG, which essentially means you don't have heart block. This is probably a good thing. You become dizzy when standing after not eating, drinking alcohol, or exercise? Sounds like you need to push hydration and get your vascular volume up. Tachycardia is a normal response when someone is dehydrated and suddenly needs increased blood pressure because they stood up.

Keep me posted on how things work out...

Best Regards,

Aaron Florkowski, MD
FAA designated Aviation Medical Examiner
www.kansascityame.com
 

Heading181

New Member
Hi Heading181,

You may be getting a little ahead of yourself. I would avoid the inclination to self diagnose. Also, when you have interactions with medical professionals you should remind them that you are pursuing FAA certification and ask them to avoid using generalized or "wastebasket" diagnoses on the chart. I'll answer your question first. If you are diagnosed with POTS you will be required to prove to the FAA that you are not at risk for a cardiac event, which could involve stress testing, holter monitoring, and evaluation by a cardiologist. You would probably be given a special issuance certificate if everything checks out.

I don't intend to treat you over the internet, but you've already said that you have a low heartrate with a good EKG, which essentially means you don't have heart block. This is probably a good thing. You become dizzy when standing after not eating, drinking alcohol, or exercise? Sounds like you need to push hydration and get your vascular volume up. Tachycardia is a normal response when someone is dehydrated and suddenly needs increased blood pressure because they stood up.

Keep me posted on how things work out...

Best Regards,

Aaron Florkowski, MD
FAA designated Aviation Medical Examiner
www.kansascityame.com
Thank you for the response! I do realize that I may be getting ahead of myself. Perhaps it is time to discuss this with my primary again to be sure he understands everything that is going on.
 

guywhoflies

Y'NO WUT IM SAYIN
Hello,

I am getting ready to take my 1st class medical and I’m worried I may be denied before I even begin my training. Over the last year or so, I have noticed that I have been getting this light headedness upon standing. I have noticed this has specifically been happening while eating lower calories and seems to be made worse after exercise or drinking alcohol. It should be noted that I have never passed out or even felt close to passing out, just at times felt like I stood up too quickly. For the longest time, I thought this was normal until I started looking it up in preparation for my medical. In the last year, I visited my GP because I seemed to have a low HR (usually in the low 50’s, sometimes in the 40’s) I had an EKG done and was told everything is normal. I am fearful this may be a condition called POTS (Postural orthostatic tachycardia syndrome.) I have an appointment with my GP coming up to discuss. My question is, if this is POTS, is it even possible to obtain a 1st class?
I appreciate your time.
My wife has POTS. It's not cardiac related, it is an autonomic nervous system issue. If your doctor thinks you may have it, they should perform a tilt table test. To be diagnosed with POTS, your heart rate must increase by 30 bpm within 10 minutes of standing. I will warn you, many doctors don't believe POTS is real. You may find doctors that think it's all in your head, you're crazy, etc. Good luck to you. If you have any questions, feel free to PM me. I can get you a lot of good information on POTS.
 

FlightSurgeon

Well-Known Member
I would work through this in a stepwise fashion. I would not recommend a tilt table test unless the FAA requests it. There are questions about the Positive Predictive Value of tilt table testing, and a positive test makes it unlikely you would be eligible for a medical certificate.

Aaron Florkowski, MD
FAA designated Aviation Medical Examiner
www.kansascityame.com
 
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