22 year old with significant dyspnea on exertion with more and more frequent premature atrial contractions unrelated to stress/anxiety

I'm an otherwise healthy 22 year old with more and more frequent palpitations and significant shortness of breath with light exercise - when even walking on a flat surface. (Many have suggested this before, but the shortness of breath and palpitations/fluttering do not relate to periods of stress/anxiety. The shortness of breath only happens on exertion, and the palpitations - which are premature atrial contractions - happen randomly.)

Does anyone have an explanation for this?

Signs and Symptoms:
-during light physical activity (walk test) HR rises up to 180 bpm, Respirations 48 (and I'm not out of shape because I'm active)
-more frequent atrial contractions from 17 years old, once a month, to 22 years old, everyday

Right Heart Cath:

pre-exercise
R atrial mean pressure: 5 mmHg
RV: 25/6
PA: 24/9 with a mean of 18
PCWP mean: 10
High SVC sat: 79%
Low SVC sat: 80%
High IVC sat: 78%
High right atrium: 82%
mid right atrium: 82%
low right atrium: 83%
RV saturation: 83%
PA sat: 84%
Peripheral artery sat: 98

Cardiac output by Fick: 5.7 L/min with cardiac index of 3.8 L/min/m2
cardiac output by thermodilution: 6.8 L/min with CI of 4.6 L/min/m2
Pulmonary vascular resistance: 1.4 wood units

cath with exercise:
baseline PA pressure initiation: 25/11 with mean of 19
peek PA: 40/10 with mean of 21
PA sat: 49%
periperhal sat: 100%
cardiac output by thermodilution: 10.1 L/min, CI of 6.8 L/min/m2


echocardiogram is normal

I also had pulmonary tests too, but I can't remember them.  They were normal

[Encephalomalcia]

I am wondering if this is a adrenaline problem.  I have this and it causes are licorce, exercise, and caffeine.  My symptoms are heart racing sometimes even with rest sitting, sometimes when climbing stairs hard to breath and puffing, walking fast hard time breathing and cannot walk as fast as others over my age.  I have add stress tests, echocardiograms, ekgs etc.  Everything is normal.  The doctor said that the adrenaline problem is really nothing to be concerned about and will not shorten my life.  I have not been able to ride a bike since I was 23.  When at the gym, I am usually told to get off the bike.  I cannot run, my heart speeds up too fast.  I pass out easily when trying to push myself, but now know the warning signs and can stop myself from passing out.  It was worse when I was younger and I have less episodes now that I am 44.  Sometimes my heart takes off racing for 24 to 48 hours.  It is exhausting and I feel tired for a couple of days afterwards.  There are a few of my uncles who have this on my dad's side of the family.  

I would start a daily log and write down what you ate and what you were doing before the symptoms happened.  Hopefully, the doctors will be able to figure it out.  Check your heart rate daily also and log it.  

Hope this helps.

Deb

[bearjenn]

I have PAC's all my awake hours as found by 48 hour holter.  Echo did not show any further diagnosis.  Treatment by doctor was beta-blockers which seem to be making my functioning worse, ie., tiredness with exertion and more noticeable palpitations at night and when I'm sick or under stress.  My doctor has also offered radio frequency ablation but I am hesitant because my sister had one done and the doctor ablated her sinus node so that she had to be on a permanent pacemaker.  Soon after, she died.  However, ablation is still an option with reassurances from my doctor I hope to get if I'm going to actually do an ablation.  

[grendslori]

"And I'm not out of shape because I'm active."

If that is the case, it's not your heart that is the problem; if it were, you wouldn't be active. PACs are normal in all people, everyone has PAC's and they are really nothing to worry about. How is your bloodwork? Any possibilty of you being anemic?