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What would cause these symptoms in a young female (+48h HOLTER RESULTS)

This is regarding myself.

Age/ Sex: 23, F

No significant medical or surgical history, no previous medical diagnoses
Psychiatry history of depression, ADHD, anxiety---> Currently tx with long-term psychiatrist.

Medications:
50- 100mg Trazodone daily PRN for sleep/ anxiety (taken at bedtime usually for recent onset insomnia)
35 mg Seroquel daily PRN for sleep/anxiety (also taken at night for sleep new onset insomnia)
100 mg Pristiq daily (depression)
30 mg Pantoloc daily (acid reflux and nausea)
30-60 mg Vyvanse daily PRN (ADHD; not taken every day, always taken in divided dose) (JUST STARTED this MARCH 2017)

Other info: Little to no caffeine intake daily

Pertinent Medical hx:
* since 12 years of age have had 5 or 6 Holter Monitor Rx's in lifetime, only did the monitor twice; 1 at 12 years old, 1 THIS MONTH at 23 years old.
* Holter at 12 years old for c/o SOB, dizziness, headache, palpitations.
Holter showed HR fluctuating up to 130 bpm (SINUS TACHY) more than once, cannot recall anything else the Doctor told me.
* EMERGENCY visit at 21 years old: HR 180 bpm (told was SINUS TACHY [difficult to believe]), sustained for several hours, give LORAZEPAM 20mg (SL) and after 1 hour fell asleep with HR 160-180 bpm still, woke up 1 hour later with HR 125 bpm and discharged with Holter Rx (DID NOT FOLLOW UP or do holter)  

* HAVE NEVER SEEN HR UNDER 105 BPM in entire life.


Symptoms (*Sx are INCREASINGLY worse over past 2 years; now almost debilitating):
* Palpitations (ALL DAY EVERYDAY)
* "Episodes" of worse palpitations with worsening sx at least once daily, often lasting hours long. This makes it hard to sleep.
* dizziness, lightheadedness, PRE-SYNCOPE
* almost blacking-out on standing (not every time but often enough)
* periods (1-2 sec.) of lightheadedness, facial tingling to rt side, with vision disturbance.
* EXERCISE INTOLERANT
* increase of HR by 30 bpm on standing
* unusually rapid/high increase in HR on exercise

HOLTER REPORT:
MINIMUM HR: 55 bpm at 1:24pm
MAXIMUM HR: 170 bpm at 1:50am
AVG HR: 105 bpm

HRV
ASDNN 5: 33.5 msec
SDANN 5: 104.1 msec
SDNN: 106.2 msec

24 total SVE Beats
Drop/Late: 0/24
Longest N-N: 1.4 sec

INTERPRETATION:
SINUS between 55-170 bpm averaging 105 bpm.
OCCASIONAL SINUS ARRYTHMIA.
NO pauses or heart blocks
No clinically important tachy or brady arrhythmia present

ALL BLOOD WORK WNL

Emerg doc read results and Rx Metoprolol and URGENT OUTPATIENT ECHO and CARDIOLOGY CONSULT in 4 days


2 Responses
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20748650 tn?1521032211
COMMUNITY LEADER
Yeah consult cardiology and get a new look at the holter.. Thats a decent variability in heart rate.. Did yoh exercise at all while wearing the holter?
Helpful - 0
1 Comments
Not at all i was almost bed ridden still am i have a cardiology oappt at 630 am
Avatar universal
Metoprolol 100mg PO drops resting pulse from 140 bpm to 90 bpm in 15 minutes, still having episodes of 140 bpm
Helpful - 0
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