28 y/o male palpitation w/ chest pressure.

I'm a 28 y/o male 6'0 148lbs.  I began having palpitations in February of last year.   It would usually occur when I was at rest.  It would feel like a jolt in my chest w/ increased heart rate.  I had approx. 3-4 episodes of this within a two month time frame.  Durring one episode I remember the cardiac monitor showed 180bpm and irregular.

I sought out a physician after I had an episode of palpations w/ brief chest pressure and diaphoresis.  I was referred to a cardiologist who put me on a 30 day event monitor and put me on 25mg of atenolol. The monitor revealed only one episode of 8 beats of 210bpm.  I had a Echocardiogram which was normal.  I started to have episodes of fatigue w/ a feeling of being aware of my heart beat and feeling it throbbing in my neck.  This persisted for several months.  On occasion I would also have frequent episodes of irregular heart rate  I recieved numerous 12-leads durring this time which usually stated and still to this day say "Incomplete right bundle branch block" and "Sinus Arrythmia".

I was driving home one morning approx. 4-5 weeks ago and all of a sudden (and I don't know if it is related at all) I had a slight burning feeling on the back of my left hand.  When I rubbed it, instantly I felt a warm feeling rush over my body and extreme chest pressure, light headedness and a sense of impending doom lasting <10 sec after which my pulse was extremely rapid.  After a trip to the ER I was taken off the atenolol and have felt much better with no more episodes of fatigue.  A 24 monitor revealed 2 PVC's fand 30 PAC's.  I had an EP study with nothing found.  My palpitations are now more frequent and had a brief episode yesterday that seemed like the one when I was driving home only last approx. 1-2 seconds.  

Only family HX is my mother had episodes of V-Tach starting in her 30s and a sudden cardiac arrest in her late 40's. I have had no caffine in 6-7 months, I eat alot however cannot gain weight.  No significant blood test results.

[CCFheartMD11]

It is likely that the atenolol was causing your fatigue, as this is a common side effect of this medication. It sounds, though, like it was at least helping with your tachycardia and palpitations, since you are having them more frequently now that you are off the medicine. Other medications in the same class (beta blockers) will likely have the same effect, though not for sure. Another option would be a calcium channel blocker such as verapamil or diltiazem to help control your heart rate and palpitations.

It sounds like you need another Event Monitor. If your symptoms don't happen on a daily basis, then the 24-hour Holter is likely to miss things. I suspect you got an EP study because of your family history of early ventricular arrhythmia and sudden cardiac death, because most patients don't have this done to work up palpitations. It sounds like your cardiologist is doing a great job. Given the family history, it might not be unreasonable to have a cardiac MRI looking for findings consistent with hereditary cardiac disease that would put you at increased risk for arrhythmia.