Heart rate elevation and dizziness after minimal effort...

[Johnny_87]

I am a 22 year-old male and have been struggling with an elevated heart beat with extremes of 200 bpm. It all started on an ordinary day, I was sitting in the kitchen while my girlfriend was cooking and I felt a weird sensation in my head as if I was going to faint. Thu s, I went upstairs to rest for a while but this did not help, so I went outside thinking I needed fresh air, but then the fainting feeling got worse and I might have undergone a panic attack, but did not faint. By the time the ambulance came I was feeling a bit better but they took me to the hospital anyway because my heart rate was in the hundredths while resting. I had an echo and was hooked to an ECG whereby everything was normal. However, I would get the occasional sudden jump in hear rate with extremes of 160-170 bpm, but by the time the nurses got to me with the ECG it had subsided. I was given Metroprololtartraat to regulate my heart beat, and after a day or two I was released from the hospital. However, the pills made me feel very dizzy and I went to my house doctor who recommended me to not take the pills anymore and just try to relax. He thought I was still suffering from panic attacks. I stopped taking them on his advice, and felt better for a couple of days. However, it did not last long before I began feeling the elevated heart rates again. I feel it the most after I make an effort, like standing up, going to the toilet, walking etc. Yesterday I had an appointment with my house doctor and I live about 15 minutes away and couldn't continue after 3-4 minutes walking. Clocked my heart rate at about 200bpm, freaked out, took a seat until a friend offered to take me there by car. Today I went to the bank which is like 10 minutes away, felt like a marathon, and now I'm back home feeling dizzy. My cardiologist told me that he wanted to do an Electrophysiology (EP) Test with me. What is wrong with me?

[Heiferly]

I assumed from the way you phrased things that by EP test you mean an EP study, where they have you in the cath lab and go in through a vessel in the groin and thread all the way up into the heart to check the electrical pathways through the heart to look for extra pathways, certain arrhythmias, etc.  Is this the test your cardiologist is suggesting?  (If so, if it makes you feel any better, I had the test myself and it wasn't horrific.  Though my mother said she felt rather stressed waiting for me to be done with the procedure.  But yeah, it was easy enough on my end of things.)  Please note that if they bring up the option of ablation, POTS should be thoroughly ruled out first, as ablation has been found to worsen POTS.

As SurgiMenopause astutely suggested, a tilt table test would likely be appropriate as you seem to have symptoms brought on by exertion and being in the upright position and alleviated by getting off your feet.  She is also correct that there are a number of laboratory tests that may be helpful in ruling out other possible causes/contributing factors; electrolytes have likely already been checked but if not, add those to the list.  If your cardiologist hasn't ordered a holter monitor yet, that might be helpful as well.

You may find some items of interest in our health pages:

http://www.medhelp.org/health_pages/Neurological-Disorders/Further-Reading-on-Dysautonomia/show/696?cid=196

http://www.medhelp.org/health_pages/Neurological-Disorders/Autonomic-Dysfunction-FAQ/show/181?cid=196

http://www.medhelp.org/health_pages/Neurological-Disorders/Diagnosing-Dysautonomia/show/827?cid=196

[LivingInHope]

You are in the right place- was the EP test he wanted to do a tilt table test?  The fact you say the tachycardia can be brought on by getting up- standing, walking, would be good reasons to to the tilt table, to see if you might have an orthostatic intolerance condition, whether it be orthostatic hypotension, postural orthostatic tachycardia syndrome, or something else.

Have they ruled out SVT (supraventricular tachycardia), which can cause super fast heart rates to happen?  

Have they verified your ferritin is normal (iron deficiency can cause tachycardia) and your thyroid function is normal (hyperthyroidism can cause tachycardia and cause extreme nervousness)?

Have they ruled out a rare tumor called pheochromocytoma (which can cause tachycardia and spikes in blood pressure with large emissions of catecholamines) with a plasma free metanephrines test?

[Johnny_87]

I think I might have posted this in the wrong thread, my apologies if so.