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HomeAnswersFamily PhysicianpheochromocytomaI have fluctuating heart rate inspite of normal EKG. Why?

Do fluctuating bpm with chest discomfort reveal autonomic dysfunction?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Mashfika N Alam

Medically reviewed by

iCliniq medical review team

Published At December 29, 2019
Reviewed AtJune 27, 2023

Patient's Query

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.

Hello,

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

Phaeochromocytoma.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Mashfika N Alam

Dr. Mashfika N Alam

General Practitioner

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