Sinus Tach and Pheochromocytoma?

[fallingapart40]

Went for a second opinion today because my original dr said that sinus tach was nothing to worry about and that the angina I had was from costochondritis. He basically said "you are fine - come back if you have something more significant happen. I thought the 226 bpm I had was pretty significant but he didn't - just said "lay off salt, lose some weight, exercise more, avoid alcohol and smoking (which I don't do anyway!) and you will be better." I asked about the significant swelling in my left foot and he said oh your heart is fine, structurally no issues at all; your stress test showed no blockages -so it can't be cardiac related and I am not a podiatrist. Well, $4000 tests- I thought should be better explained and my symptoms more of a concern since they are still present just not as pronounced.

So far I have had a CT of my lungs to rule out blood clots - clear; 3 ekgs - all with abnormal T waves and all with sinus tachycardia; complete metabolic panel, lipids, thyroid screen; nuclear stress, and echo - all that came out "fine" I am told. No explanation for the constant swelling in my left foot/ankle area that gets worse with being on it and never goes all the way down.

Today, the dr I saw asked me the whole story from the onset of symptoms and after conversation and exam, he said we need to rule out pheochromocytoma first.... Not sure about this as I have never heard of it. I looked it up and don't know that I really fit the mold...I do have the tachycardia that is episodically worse at times running from 110-225 but can go to 75-80 ,especially at rest; tremors/shaking in my hands; edema of left foot (he also found today that the entire lower left leg has edema as my legs have a 2 cm difference in circumference that I had not even noticed); I have a history of migraines; I have black "spots" in my peripheral vision sometimes; have dizziness and lightheadedness sometimes- especially with high tach; not found the blood pressure to be high - sometimes it is low; I have angina with the high tach and sometimes headaches that I thought were tension; I do get the "cold sweats" if I have a reactive hypoglycemic attack that also comes with tach, headache, lightheadedness but rest, food and/or drink usually clear this within 30 minutes.

Any ideas or suggestions for other possible causes?
How is the 24 urine hour test administered (at home - clinically)?

Thanks for any help you can give...

I went from thinking I got spider bitten, to possible cardiac problems to this.... I hope this roller coaster ride ends soon!

[DrNoopurMD]

Hi,

How are you?
Phaeochromocytoma is a possibility especially when you have symptoms like tachycardia, headaches, palpitations, anxiety and excessive sweating.
A 24 hr urine collection is generally ordered and analysed for urinary catecholamines. You will receive a large and small urine specimen container. The containers may contain preservative so keep them away from children
You need to discard the first specimen which will be the early morning specimen. Note the time and from then on collect your urine in the small container and keep emptying it into the large container. Make sure you do not lose any specimen and take it to the lab the next day when your 24 hrs are over.
Hope this helps!

[fallingapart40]

It does help, especially to know what to expect... thanks for answering!

Are there other diagnosis possibilities that are as plausible?