Chonic chest pain + low blood pressure + Normal ECG with sinusal arrhythmia

Hi, 35 yo man, weight 160 pounds, I eat heatly since a while (no sugar, no caffeine, no soda), i'm not physically active cause I have exercise intolerance since 1 year, I smoke 1 pack a day and try to quit often, severe anxiety and panic disorder problems NOT under control (taking 6 mg of Rivotril day + 1 mg of Xanax) and live with a long list of symptoms (mainly cardiovascular) everyday since 1 year. Done 3 CBT in the last year with no improve, i'm med sensitive (they all trigger cardiovascular symptoms and increase my anxiety).

I'm taking a low dose of Inderal 2,5mg each morning for a tachycardia problem who start last february (had one episode of supraventricular tachycardia with a normal ECG result in february). Since then, I deal with tachycardia every time I get up in the morning, sometimes after a nap in the afternoon or in the middle of the night with a pulse rate of 130-160 when i'm standing who decrease to 70 or lower when i'm sit and lower in the evening, sometimes around 50-55. I wear a holter monitor 24 hours last february and my Cardiologist say everything was normal, just had a fast pulse rate in the morning and at night and put me on a beta-blocker for the tachycardia and it was working not so bad until july.

In july, I start having a low blood pressure everyday, higher in the morning (around 115/60) and decrease in the afternoon and evening to 90-105/50-55. The lower is the diastolic number and the higher I will have chest pain. I know it's not related to my anxiety level cause I didn't had a full blow panic attack since a while and even a panic attack attack last only 10-15 minutes and don't last all day long.

I have all the time a pounding heart beat, can feel it all the time when i'm sit, standing or lying in my bed, my heart beat stronger than usual and I can see my legs and hands shaking with each heart beat. It canno't be from too much adrenaline level cause I had a 24 hours urinary test for my adrenal glands in march and my adrenaline level is vey low, my cortisol level is also low, the noradrenaline level is in the middle range and the dopamine level is near the upper limit.

I also have what I call angina pain at rest who last all day long, sharp pain in my chest with extreme jaw pain (like all my teeth will fall), neck pain, pain in my left arm and sometimes in my left upper and lower leg...it's milder in the morning and become stronger in the afternoon and worse in the evening, especially after a meal, the pain seem to not be trigger by exercises and happen more when i'm sit, when I experience a lot of anxiety or when I do nothing and only watch the TV (but my Cardiologist say it's not from my heart apparently...). IT can happen also when I do task who ask for more memory like writing a thread here, or doing some foods...Just to clarify everything, I had a gastroscopy and the chest pian is not related to a GERD problem. Also had a stress-test on a treadmill in 2010 with an echochardiogram who was normal at the time, but I was physically active in the begining of 2010, only had the stress-test cause I had a low pulse rate all the time at the time. I also had one holter monitor 24 hours test in 2010 who was normal, just show the low pulse rate, at the time I wasn't on a beta-blocker med and my anxiety was a little bit more under control, was able to drive my car and go out of the house with my friends...

I also have weird blood pressure reading, higher when I lie down, lower when i'm sit and more lower when i'm standing, the systolic reading is around 100 sit and decrease to 85-90 when i'm standing BUT the diastolic increase from each position from 50-55 to 60-70... those weird blood pressure reading when i'm changing from a sit position to a standing one generate what I call orthostatic hypotension episode, have them all the time when I get up and i'm dizzy, confuse, my vision turn black, have tinnitus... those episodes last around 30 seconds and happen only when I get up.

Of course, I increase my salt intake, drink more water but it's seem to make me feel more bad, my blood pressure don't increase and the more I eat or drink and the more I have chest pain and headache and a pounding heart beat.

This week, I had to go to the ER again, my third time this year for the chest pain and weird blood pressure. I had the regular ECG test, who is normal BUT with sinusal arrhythmia, mean that when I breath my pulse rate decrease... the Doc at the ER told me it was normal and not dangerous. I also had a X-ray of my lungs who is normal and all my blood tests are perfect. For the blood test, all the electrolytes and metabolites results are ok (creatine, urea, glucose, sodium, potassium, Chloride, CO2, Amylase-P). The blood tests for the liver are also perfect (Gamma glutamyl transferase is near the lower limit, Alkaline phosphatase is near the upper limit, Aspartate transaminase and Alanine transaminase  are in the middle range, Total Bilirubin is also perfect). The coagulation of the blood seem to be ok also with an INR values of 1,1 and a partial thromboplastin time (PTT) of 28,4 sec. Cardiovascular markers are normal also with the creatine kinase (CK) at 74 U/L (normal values are between 50 and 200), the Troponin-I result is also normal with <0,02 UG/L (normal values is <0,04). The hematology results are ok also (red and white blood cells with the exception of the mean corpuscular hemoglobin (MCH) who is higher at 33 (normal values are between 27 and 32).

The Doc at the emergency didn't explain to me why I had the pounding heart all the time, also didin't find anything to say about the chest pain, he told me it was anxiety related... For the weird blood pressure he can't find an answer, saying that my Inderal dose of only 2.5 mg will not affect my blood pressure and is more like a placebo dose.

The main problem is that even if I had all those tests run 2 days ago, I have the same problems. My chest pain is strong, my blood pressure is also low, just stand after being sit 20 minutes and got dizzy for 30 seconds. I continue to have the very fast pulse rate in the morning and all the other symptoms...

I wait for the phone call from my Cardiologist, he is on vacation right now. What kind of heart test should I ask to him? I also see my Family Doc next week and wondering what I can ask to him about my heart? I think that I may have something call postural tachycardia and that i'm in a very bad physical shape like a deconditioning state with a decrease of physiological adaptation to normal conditions who are the result of a decreased physical activity, since I have a lot of cardiovascular symptoms and fear to die from a heart attack...

I also have weird cardio reactions when I take my calcium supplement with my high dose of Vitamin D (50 000 units - cause I had a gastric by-pass to loose some weight and can't absorb very well the fat solube vitamins). So I take only 50 mg of Calium insistead of 500 mg day like before... and take my Vitamin D only 1 day on 2... They both lower more my blood pressure and increase my chest pain. Same for the Vitamin A and the Iron, I had to reduce both of them, was at 600 mg of iron day and decrease at 300 mg and was at 30 000 units of Vit A every day and decrease to only 10 000 units day... but I have to be carefull cause I don't want to have anemia again like in the past.

Anyway, someone have an idea about what happen? For the normal ECG with not normal sinusal arrhythmia, what that's mean? My ECG is normal or not? That's confusing...

Thanks!

PS: I know I post another thread 1 week ago, but since I goes to the ER and have results from the blood tests and ECG, that's why I start a new thread...