Palpitations and Fatigue

[Emilyrahimi]

I am a 27-year-old female. About two years ago I became ill with neck pain (up the sides of my neck), heart palpitations and extreme fatigue (I slept about 16 hours a day) for two days. The following day I passed out after standing for about 10 minutes on my way to work (I had never passed out before that day). Since then I have experienced palpitations several times a week, extreme fatigue (sleeping at least 12-14 hours a night) and difficulty standing for more than about 10 minutes at a time (I will get extremely hot, start losing my vision and possibly faint if I stand longer). The doctors hooked me up to a holter monitor when this first happened, which registered my heart rate to get as high as 170 with a regular rythem. The doctor gave me Atenolol, but since it did not seem to provide any real help, he took me off the drug. I also had an Echo test which noted mild MVP. Additionally, I have been given an EKG, tilt test and stress test, all of which were normal. I also had a thyroid uptake exam which had low-normal results. I also normally have low blood pressure.

I am wondering if you may be able to think of something that my doctor may be missing? I am not concerned that this condition is dangerous, but it becomes extremely cumbersome and I find it diffiuclt to function normally.

[CCF-M.D.-MJM]

Hi Emily,

You are right, the condition is unlikely to be dangerous short of passing out a very bad time.

It sounds like you may have postural orthostatic hypotension (POTS).  I am surprised your tilt table was not positive based on the symptoms you describe.

If I say you in clinic, I would probably try another beta blocker.  I am not sure why atenolol didn't work--it sounds like it sould help.  We see quite a few people with the symptoms you describe and they usually have POTS.  It is very difficult to treat, but usually involves a beta blocker and sometimes salt tablets.

I am guessing the holter showed sinus tachycardia with a gradual increase and decrease rather than an arrhythmia.

I hope this advice helps, but I know this a notoriously difficult condition to treat.

Good luck and happy holidays.

[hankstar]

I will be most interested to see the doctors reply. I had these symptoms from time to time also, but not the sleeping part.

One thing comes to mind carotidynia, an inflammation of the carotids, the large arteries that carry blood to the brain.

I never passed out but felt very hot and fatigued with a rapid pulse, fortunately atenolol does help with the pulse rate, but I still get that hot flushed feeling at times and a soreness on both sides of the neck , sometime just one side.

I have ankylosing spondylitis a connective tissue disease that can intermittent inflamation (inflammation) like this from time to time, usually a mild form of vasculitis. I have never bee formally diagnosed with carotidynia, but did bring it up to my internist on one occasion and he stated that many connective tissue disease can cause it and agreed it could be the cause.

  Autonomic dysfunction cn also produce very similiar symptoms.

Good luck, hope you feel better, Happy Holidays.

[Emilyrahimi]

Thank you so much for your response.

If you have time, I was wondering if I could ask your opinion about the tilt table test I was given. My test looked at my response to an extreme burst of adrenaline (via an iv) and I was only in the standing position for a couple of minutes. I've heard of people taking the test and being asked to stand for 30 minutes to an hour. Should I ask to have that test administered instead?

Thank you again for your advice and have a happy holiday.

[TITUS]

Did they do a complete blood workup and check for electrolyte imbalances or dehydration?