Postural orthostatic tachycardia

[Heading181]

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]

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]

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]

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]

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

 

[Torie]

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

Aaron I have a similar question. I have been diagnosed with POTS by my EDS specialist Dr. Sarah Stewart. I have not had a tilt table test. I've focused on paying off my house before I invested in a second career and I am trying to become a pilot. I've been working ground crew most of my 20's and I'm very familiar with most all of aviation except for piloting a plane. I haven't flown anything yet because it's expensive, and I'm concerned that having POTS will disqualify me from flying. POTS is not a heart condition, but a neurological condition. I went undiagnosed until I was hit by a car as a pedestrian because my symptoms were mild. I am still recovering and in my down time I've been trying to make a plan moving forward in my life. Is a diagnosis of POTS a hard no? Maybe I can get a second or third class? Would I need to maybe go the special issuance route? All I really want is to eventually fly helicopters for fire support. I know asking here and basing my future decisions on a post is a long shot, but if it's already a hard no that hurts $175 less (I know I checked). You can also respond to me via email if anyone knows more about this:
toriemosdal@gmail.com

 

[FlightSurgeon]

Torie,

It creates an uphill path for you, I wouldn't say it is a hard no without knowing more about the rest of your medical history. You say you have an EDS doctor, what does that stand for? Ehlers Danlos?

I think you would expect a deferral of your application, followed by a thorough review of your cardiac/neurological evaluation. At that point the FAA may consider a special issuance if you haven't had any fainting/dizziness.

This is common advice here but consider using a service to review your case before going to the FAA. leftseat.com is one, but if you search the boards you will find others as well.

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

 

[Torie]

Aaron,
Thank you! After getting hit I did struggle with fainting and dizziness. I got IV infusions to help increase my blood volume for 6 months before we found a medication that really helped me. Staying active also has strengthend my heart and has helped. I am still recovering, and looking forward to the possibly of flying is helping me recover. I always know when I am going to be dizzy or faint, and I rarely faint. It's only after a long day in the evenings, and that was before I found a medication plan that worked for me. I don't want to ever put anyone else at risk, but they haven't taken my driver's license. I'll look into leftseat, thank you so much for your response.

-Torie

 

[Torie]

Torie,

It creates an uphill path for you, I wouldn't say it is a hard no without knowing more about the rest of your medical history. You say you have an EDS doctor, what does that stand for? Ehlers Danlos?

I think you would expect a deferral of your application, followed by a thorough review of your cardiac/neurological evaluation. At that point the FAA may consider a special issuance if you haven't had any fainting/dizziness.

This is common advice here but consider using a service to review your case before going to the FAA. leftseat.com is one, but if you search the boards you will find others as well.

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

*Also yes, I have hEDS (Ehelors Danlos)
It's the type where I'm very bendy, but not the one where my heart has problems (outside of POTS)