Traumatic Motor Vehicle Accident Results in POTS

This case involves a twenty-eight-year-old female patient who was in a traumatic motor vehicle accident that left her with several complications. She had been attempting to adjust the AC and heat controls on her Jeep Wrangler when another vehicle collided with her, causing a devastating crash that left her severely injured. The most debilitating was her battle with postural orthostatic tachycardia syndrome (POTS) that developed shortly after her discharge from the hospital. For over a year, the patient was always tired, had intermittent chest pain, became overheated easily, and had excruciating headaches on a daily basis. Various medical specialists, including a cardiologist, rheumatologist, and neurologist failed to find a physical cause for her symptoms. Some physicians claimed she should see a psychiatrist because she was malingering, depressed, manipulative, and overly anxious, which necessitated psychotropic medication.

Question(s) For Expert Witness

1. Is it possible that this condition was linked to the motor vehicle accident?

Expert Witness Response E-006006

The last two decades have witnessed a dramatic and substantial increase in our understanding of illnesses that result from disturbances in the autonomic nervous system. Initially, these investigations were focused on neurocardiogenic syncope. It soon became evident, however, that a subgroup of patients suffered from a similar yet distinct type of autonomic disturbance manifested by postural tachycardia, orthostatic and exercise intolerance, and fatigue. This disorder has come to be known as the postural orthostatic tachycardia syndrome (POTS) and appears to be a heterogeneous group of disorders that display similar clinical characteristics. The most frequent form of primary POTS is the “partial dysautonomic” (or PD) form, which has yet to be linked to trauma such as a motor vehicle accident.