nausea / fast heartrate

Dr.,

I'm 41 healthy male, who has had 4 episodes in last 6 months.  Each time, I've had waves of nausea lasting a few minutes, with what seems like a normal heart rate, where these waves grow in intensity until finally it feels like I will vomit, but I don't and this is followed by a fast heartrate say about 2x normal that quickly speeds up and slowly slows down to normal.  There's no pain or tightness during these events but they are scary.  
After the last time I went to local doc. who did EKG and blood enzymes which were normal.

Also, I've noticed recently at times I seem to be fairly tired, esp. after a large meal.

I've had no previous heart trouble; at age 38 my cholesterol was 233, and with diet + fish oil have since lowered to 194 with 140LDL and 53 HDL; triglycerides, CRP, and blood pressure all low.

Does this sound like something heart-related to worry about, or could this be more anxiety/stress related?  Each time the episodes have happened I've been at rest but they've been on a day where I haven't had much sleep.

thanks

[Lee Kirksey, MD]

Hello
Given your premature elevated cholesterol, I think that their is elevated suspicion for cardiovascular disease. Having said that- a number of other things like your caffeine intake, stress and medications can influence the development of rapid heart rate. I would suggest a holter monitor to monitor the development of the arrhythmia. Also a stress test might help to differentiate a cardiac cause. Keep a diary of your food intake and list all of your meds. Good luck