Q. Do fluctuating bpm with chest discomfort reveal autonomic dysfunction?

Answered by
Dr. Mashfika N Alam
and medically reviewed by iCliniq medical review team.
Published on Dec 29, 2019

Hello doctor,

I am a 25-year-old male. My bpm is 31 during physical and mental exhaustion but my bpm is high of about 178 during hyperventilation and has pointless frustration. My bpm from rest to stand increases by at least 30 points but averages a 50 point increase. My resting bpm is 40, and upon standing it increases to 90 and peaks up to 110.

I had done an echo cardiogram and EKG. I feel light-headed upon standing, along with sudden pulsation, headache and muscle spasms. I feel blackout, syncope, and fainting. I had spontaneous jolt, breathless, palpitations, flutters, fatigue, chills and skin rash on the back of hands.

My mental disturbances include confusion, inability to maintain thoughts. I also feel pointless random irritability, ankle pain, random lapse of balance, throbbing extremities, vibrating vision, burning sensation, social anxiety, depression, irritating bowl movements, no appetite and chest discomfort.

I wast told to mention the possibility of autonomic dysfunction as its often times overlooked.

Dr. Mashfika N Alam

Family Physician General Practitioner


Welcome to icliniq.com.

The symptoms you have been suffering from seem to point to a number of possibilities. One would initially suspect a cardiac abnormality given the drastic fluctuations in your pulse rate, but that would show up on an ECG or echo tests. Since your ECG and echo tests are normal, I would advise you to get some blood work done like, a serum electrolytes test to see if there is any hyponatremia or hyperkalemia.

Also a urine test for 24 hours urinary collection of catecholamines. Both of these tests would indicate a disorder of the adrenal gland, Addison's disease with the electrolyte abnormalities or Phaeochromocytoma, diagnosed by the 24 hours urinary catecholamines.

Please get these tests done as both these probable conditions, if present, need to be treated sooner rather than later.

I hope this helps.

Investigations to be done:

24 hours urinary catecholamines, Serum electrolytes.

Differential diagnosis:

Addison's disease. Adrenal insufficiency.

Probable diagnosis:


Was this answer helpful?


Also Read Answers From:

Comprehensive Medical Second Opinion.Submit your Case

Related Questions & Answers

What does an irregular heartbeat mean?

Query: Hello doctor, Just tonight I started having an irregular heartbeat. I have no other symptoms. I am not weak or dizzy or lightheaded. It has been going on and off for about five hours.  Read Full »

Why am I not able to control my BP with medicines?

Query: Hi doctor, I have a resistant hypertension. Even five drugs failed with a lot of side effects. I was safe on Methyldopa for 2 years with Hydrochlorothiazide. Now, there is no supply of this medicine. I started Nebivolol 5 mg with Chlorthalidone last night. I have the feel of chest tightening and sli...  Read Full »

Why am I having palpitations with high blood pressure?

Query: Hi doctor, I am 18 years old and I have started to struggle with palpitations. When I was around 12 I started having high blood pressure and since then it has not stopped. I have gotten many tests done for my heart and all have turned out normal, but I am still concerned. I do have a poor diet and ...  Read Full »



Ask your health query to a doctor online?

Ask a Family Physician Now

* guaranteed answer within 4 hours.
Enter Your Health Query
You can upload files and images in the next step.



Disclaimer: All health Q&As published on this website is not intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek the advice from your physician or other qualified health-care providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website.