Seeking Answers for Worsening Tachycardia
At the age of 23 and weighing 140 pounds, I am currently prescribed metoprolol, varying between 12.5 and 25 mg daily. Recently, after a five-day course of an inhaled steroid (Trelegy), I have been experiencing worsening tachycardia without any clear explanation from multiple specialists, including those in primary care, cardiology, electrophysiology, endocrinology, and neurology. Today, I took 37.5 mg of my medication but lie in bed wide awake, as my heart rate exceeds 100 beats per minute. This ongoing situation feels unbearable; I frequently experience deep-seated anxiety alongside intense palpitations and fluttering sensations. Typically, my medication alleviates these symptoms, but today, it seems ineffective. All conducted tests—such as echocardiograms, Holter monitors, EKGs, stress tests, complete blood counts, thyroid evaluations, and ANA tests—have returned normal results. The only exceptions were my failure on the tilt table test and some irregular lab findings indicating elevated DHEA and an abnormal aldosterone/renin ratio. However, the endocrinologist stated that a definitive diagnosis cannot be made at this time. I would greatly appreciate any suggestions for additional tests or insights into what might be causing these troubling symptoms.
Answers (1)
6/23/2025, 4:40:40 AM
OpenHealth AI
It sounds very distressing to be experiencing worsening tachycardia, especially after consulting multiple specialists without clear answers. Managing your heart rate and addressing your anxiety are essential, and I admire your proactive approach in seeking insights. Let’s break this down to understand your situation better and provide some actionable steps.
Main Points
- It’s crucial to manage both your tachycardia and anxiety.
- Your recent symptoms may potentially be influenced by medication, especially with the inhaled steroid and metoprolol dosage adjustments.
- There’s a need to monitor specific symptoms and consider practical self-care strategies.
Explanation
Tachycardia, or an elevated heart rate, can have various causes, including medication side effects, anxiety, dehydration, and other metabolic or hormonal imbalances. Given your history of normal tests except for elevated DHEA and the abnormal aldosterone/renin ratio, it’s understandable these symptoms remain puzzling. Additionally, recent changes in your medication or the inhaled steroid could trigger or exacerbate these symptoms.
Elevated DHEA (dehydroepiandrosterone) and abnormal hormonal tests can suggest an adrenal response that might influence heart rate and anxiety. Understanding how these play into your overall health could be key.
Next Steps
-
Monitor Your Heart Rate and Symptoms:
- Keep a diary of your daily heart rate, noting times of high rates and any activities or stressors coinciding with those spikes. Include your feelings of anxiety, as this can help in understanding triggers.
-
Evaluate Medication Effects:
- With any new symptoms, consider discussing the interactions between your metoprolol and Trelegy with your healthcare provider, particularly regarding how this combination affects your heart rate.
-
Anxiety Management:
- Incorporate relaxation techniques to help manage anxiety, such as deep-breathing exercises, mindfulness, or gentle yoga. These can help reduce heart rate during stressful episodes.
-
Stay Hydrated:
- Ensure you are drinking enough fluids, as dehydration can lead to elevated heart rates. Aim for at least 2 liters of water daily unless otherwise directed.
-
Consult with Your Endocrinologist:
- Given the abnormal gender hormone levels, follow up with your endocrinologist regarding the elevated DHEA levels. Further testing could be necessary to explore possible conditions related to those findings, such as adrenal gland function.
When to Seek Immediate Help
- If your heart rate continues to exceed 100 beats per minute consistently, or if you experience severe symptoms like chest pain, shortness of breath, or fainting, please reach out for immediate assistance.
Remember that managing your health can require patience, and it’s important to be gentle with yourself during this time. Each small step can lead to greater clarity and relief in how you feel. If you have more questions or need further clarification, feel free to reach out.
Related Questions
Rash on My Arm: Should I Be Concerned?
Hi there! I’m a 65-year-old female, and for the past four days, I’ve been dealing with a strange rash on my arm. Unfortunately, I can’t visit a healthcare professional until Monday, so I’m hoping to get some clarity in the meantime. I’ll share some images. If they don’t upload here, I’ll post them in the comments instead. The first image, taken last night, is a bit out of focus, but this morning, the rash has appeared even redder. Although it doesn’t itch now, I did experience some itching during the initial two days. As for my health history, I generally don’t have major health concerns apart from elevated cholesterol levels and a recent A1C reading of 5.9, but I do not have diabetes. I keep fairly active for my age group. During the first couple of days, there was some pus, and I managed to clean it with an alcohol wipe, which helped remove it. Could this be related to a spider bite? I noticed some small spiders (specifically daddy long legs) in my bedroom, especially near the balcony door, and I eliminated a few of them today, so that could be a possibility. Should I be wary of any serious complications from this rash? Any advice would be immensely appreciated! My ER co-payment is quite steep, and there’s no urgent care facility nearby. My only option is to request an appointment with my primary care physician next week, but I’m uncertain if it’s something that warrants immediate attention.
Navigating Recurrent Prostate Cancer: A Patient's Journey
As a 60-year-old man living in New York, I faced a challenging battle with prostate cancer approximately 4.5 years ago. My initial biopsy results indicated a Gleason score of 6. However, in September 2025, my PSA levels alarmingly soared to 27.7. To investigate the possibility of an infection, my doctor prescribed a month-long course of antibiotics. Afterward, my PSA levels showed a slight reduction, dropping to 25.5. Following another biopsy procedure, the Gleason score unexpectedly escalated to 10. This prompted serious discussions with my healthcare provider. He explained that, given the radiation treatment I had previously undergone, the surgical removal of my prostate would be quite complex, with very few surgeons willing to perform such a procedure. Consequently, I sought a second opinion from a specialist in urological cancer. The specialist echoed similar concerns, indicating that the potential complications could severely affect the urethra and rectal lining. Instead of surgery, he proposed cryoablation as a viable alternative. Simultaneously, I commenced treatment with testosterone hormone blockers. To say that this experience has been frustrating is an understatement. Most importantly, I also struggle with urination issues that complicate my daily life. I am reaching out for any insights or advice that might assist me in navigating this difficult situation.
Experiencing Widespread Muscle Weakness
I’m a 36-year-old male and have recently been facing a troubling situation where the muscles throughout my body seem to be losing function—including my eyelids. The trouble began in May 2021 when I lifted a heavy garbage can with my right arm in a shrugging action. Following that, I felt a combination of pain and weakness concentrated in my right shoulder blade, as well as my shoulder and collarbone. Soon after, I noticed my shoulder began to pop and click. Afterward, I consulted with an orthopedic specialist who conducted x-rays on both of my shoulders. He informed me that everything appeared normal and dismissed the popping sounds as inconsequential. I also mentioned experiencing neck pain, but he indicated that addressing neck issues wasn’t his area of expertise. He diagnosed me with bilateral shoulder and neck discomfort and recommended physical therapy. The day after my appointment, I attempted to adjust my position in my desk chair by leaning on the left armrest, putting my forearm under the weight of my body. Suddenly, my shoulder jolted, and I felt a sharp weakness in my arm, accompanied by popping and clicking noises, similar to what happened with my right arm. I reached out to the orthopedic office to inform them about this incident, but the physician assistant who responded said the doctor would not see me again simply due to how I was sitting, and suggested I attend physical therapy first. She mentioned that if I continued to experience weakness, a neurologist might be necessary. Feeling concerned, I returned to my primary care physician for a follow-up appointment and recounted my experience. He didn’t appear worried, and my blood tests returned normal results. During the summer of 2021, I began physical therapy where the therapist diagnosed me with strains in my trapezius and rhomboid muscles. The subsequent therapy sessions consisted of painful exercises and stretches, yet I observed little to no improvement in terms of strength or stability. Activities like using the arm bike and weight machine were excruciating, and I frequently inquired whether my symptoms could be attributed to a tear or nerve damage, but the therapist insisted that was not the case and dismissed my concerns. After my tenth session, I decided it was best not to return. In April 2022, I visited a neurologist. I struggled to lift myself onto the examination table and needed assistance from a step stool. He didn't suspect any neurological issues when I asked him about an EMG or other assessments, he declined to proceed with those tests. Disheartened by these experiences, I chose not to pursue further medical consultations. Fast forward to April 9, 2025, I misstepped while descending some stairs, causing my right heel to catch, and I landed hard with my toes pointed. I had no visible signs of injury such as swelling or bruising, but soon after, I began to experience persistent pain and weakness, especially in my toes and the arch of my foot. By April 13, I instinctively elevated the toes on my left foot, and to my dismay, the same pain and weakness emerged, again without any visible signs like bruising. Since then, both feet have lacked strength, and my big toes feel unusually floppy. In July 2025, I had a troubling experience after having my hair washed at a salon. I held my neck in an awkward position for the duration, which resulted in a burning sensation. Regrettably, I didn’t express my discomfort, fearing a scene. Following this, I noticed significant weakness in the muscles at the front of my neck, under my chin, which gave the appearance of a receding chin. Additionally, my facial muscles, particularly in my cheeks, felt weak and could easily be pressed in with minimal resistance. In January 2026, I bought a new game controller for my laptop, having not played video games for a long time. Initially, it was manageable, but soon after, my hands and forearms began to feel uncomfortable and painful. This discomfort escalated significantly to where I had to discontinue use completely; my hands felt drained of energy and experienced achiness, tingling, and numbness. Then, on February 3, 2026, while seated and using my laptop, I noticed a peculiar sensation when moving my eyes. My eyelid muscles felt weak, and one of my eyelids began twitching. I found it increasingly difficult to open my eyes as widely as I used to. I plan to see a primary care physician once more, but I’m uncertain how to communicate all of this effectively to receive proper care. My circumstances have reached a point where my parents must assist me with everyday tasks, including driving, opening doors, and even lifting light objects. My ability to raise my arms above my head has become severely limited as well.
Liver Mass Assessment
Patient Profile: - Age: 61 years - Height: 5'9" - Weight: 240 lbs - Gender: Female - Lifestyle: Non-drinker, non-smoker, no illicit drugs Current Medications: - Atenolol 10mg (morning and evening) - Rosuvastatin 40mg (evening) - Duloxetine 60mg (evening) - Spironolactone 25mg (recently added) - Jardiance 10mg (recently added) Medical History: The patient has a notable history of multiple pheochromocytomas and paragangliomas, having undergone surgery on eight occasions. According to scans performed three years ago, two subcentimeter retroperitoneal masses were identified, suggestive of potential paraganglioma. Additionally, she suffers from secondary polycythemia and possesses the PHD1 gene mutation. Previously, she received treatment at a prominent research institution in the United States. However, her endocrinologist has since retired and returned to their home country. Current Condition: At present, she is mostly asymptomatic. However, in January 2026, she experienced a concerning event requiring an ambulance transport to a local emergency room, where her oxygen levels registered at 88-89%. This incident was unsettling, given her extensive medical history. The emergency physician initially diagnosed her with congestive heart failure (CHF), but upon discharge, her family medicine doctor suggested pneumonia. During her hospital stay, a cardiologist—who has never managed a pheochromocytoma patient—recommended a chemical stress test. A CT scan performed on her chest revealed a 3.2 x 2.5 cm mass located in the left lobe of her liver. Her blood tests typically show elevated levels related to pheochromocytomas; however, the laboratory does not conduct resting catecholamine testing, which leads to unreliable results, despite them being consistent over time. Furthermore, she has received care at major hospitals in Minnesota and both leading hospitals in Cleveland, Ohio. Unfortunately, when she required her last surgery, the tumor board declined her case, citing an unfavorable risk-benefit ratio. This leaves her without a specialist in pheochromocytomas. Request for Guidance: The patient is seeking advice or recommendations for her current health situation and management of her conditions.
Concerns About My Daughter's Morning Health Issues
My 17-year-old daughter experiences troubling symptoms each morning, particularly on days when she needs to rise early for school or work. She often wakes up feeling dizzy and nauseated, accompanied by a rapid heartbeat exceeding 100 beats per minute. This situation prevents her from being able to eat and may persist for several hours, or in some cases, throughout the entire day. Standing at 5 feet 8 inches tall (172 cm) and weighing 121 pounds (55 kg), her physical health otherwise seems fine. I have a personal history of inappropriate sinus tachycardia (IST), which is why I take beta-blockers for management. A few years ago, she consulted a cardiologist regarding her frequent episodes of near-fainting, who recommended increasing her water intake and adding more salt to her meals. Given the persistent nature of her symptoms, I am contemplating whether a follow-up appointment with the cardiologist is warranted, especially since all previous tests, including ECG and ultrasound, came back normal. This situation significantly affects her daily life, restricting her ability to engage fully in school and work. Any suggestions would be greatly appreciated!