erik

I just hopped over to a different browser and that same link brought up the whole article for me still (and offers full PDF version too). I don't know if they give "random samples" and I'm just lucky??? I take it the whole article didn't come up for you?

I had pulse spikes like that in my own overnight self-studies (with a pulse-ox). While they are "associated" with various sleep disturbances and are probably a good clue... they aren't considered "diagnostic" for apnea at least. Gotta go by the more direct stuff like chest expansion, air flow, blood O2 & CO2, EEG, etc. at least according to these folks: http://www.sleep-journal.com/article/S1389...0198-9/abstract I like the WebMD page on central apnea (mostly because I have all the symptoms : http://www.webmd.com/sleep-disorders/central-sleep-apnea Plenty of other things can disturb sleep too. And there might be clues in subtle HPA changes that POTSies & such may share with folks like PTSDers and others (not to mention crossover folks): http://www.nature.com/npp/journal/v28/n9/full/1300215a.html Maybe studies will eventually probe out the subtle things as well as the big ones.

Standing in line is probably the worst thing in normal life for me too. Wiggling, tightening muscles, rocking the feet, all that stuff might help a little. Then again, some days not much is going to avert things. I'm at least happy to know that I don't have some bizzare phobia of checkstands or whatever... that I wasn't having a flashback of molestation by a grocery store teller or something!!! It's a "blood stalling out" problem for the most part. My favorite recollection of this was when I came close to fainting while waiting at WalMart to refill my fludrocortisone prescription! Building blood volume can help some folks. It helps me a lot most of the time. Fludro, NSAIDS, DDAVP, EPO, exercise, salt/water, being upright more if not already... these things are said to promote blood volume. Its a good place to start.

For good nighttime reading material (I always fall asleep after a paragraph or two of stuff like this): http://theoncologist.alphamedpress.org/cgi...t/full/13/7/779 They mention that other things can elevate catecolamines... medications, depression, panic disorder, congestive heart failure. I'm pretty sure we can confidently add POTS/dysautonomia to that list, since it's right in the ballpark physiologically and by association to all of those things. (Maybe even hypoglycemia can do this???) Then if elevated levels are found, that's when the Clonodine suppression test comes in handy... to try to distinguish from various reasons things could be elevated. To weed out a false positive. I don't see an easy chart of "how high is way high", but the elevated metanephrine (a metabolite of adrenaline, I think) might even just be regular stress and/or POTS stuff. A doc may not even see reason for any followup test here since POTS is there as a viable explanation. I am just guessing about the doctor... not trying to make any diagnosis here... that would be inappropriate! The 2008 sitting and standing seem to be below the H-POTS cutoffs that places use too... so you might even be most likely "PD-POTS" rather than "H-POTS". This might also imply they're below "likely pheo" levels too??? I don't know. Of course, these are judgment calls to be made by proper medical folk!

Obstructive refers to an anatomical obstruction of airflow... like stuff near the tonsils (adenoids???) or stuff like that (glottal parts falling in bad positions or whatever, disgruntled wives "accidentally" placing a pillow in an inconvenient location)... or an otherwise blocked/restricted airway. Central refers, usually, to brain trunk problem... where the ANS is "deciding" not to breath rather than "tolerating" some lack of breathing. Central is said to be incredibly rare... "it is said" that those who have central, more often have "mixed", which means both central & obstructive combined. Statistics are nice and all... but zebras are statistictaphobic. Intuitively, it sure seems like folks with ANS trouble would lean toward "central or mixed", but I've not bumped in to any statistics or "science" in that regard. Apnea can create symptoms very much like dysautonomia. It seems to have gained "recognition" in somewhat recent years, so docs are screening for it way more than before. One concern is that like many things, it can create/promote a harmful cycle where modest or transient trouble then induces some persistent (but initially minimal) damage. Then that damage pushes further to dysregulation and further apnea. And the cycle spirals to bad effect. It seems wise to screen and prevent as best one can. There are also "theories" about brain & nerve regeneration being somewhat resilient, so long as supportive circumstance exists (and maybe future med interventions will assist). "Chronic hypoxia", "Apneas", etc. don't seem so different from dysautonomia with so called "chronic blood flow disturbances". Brain trunk damage is one "known" cause of dysautonomia... perhaps not "common", but known. The brain trunk is the ANS brain, in a simple way of putting it. Anecdotally, when I first saw my doc & described myself... his first recommendation was sleep study to screen for sleep apnea. (I skipped that so far, but will get to it some day). One cannot do a useful "home screening" for sleep apnea without, as yet rare devices... but it was my attempting an amateur apnea screening that made my "odd pulse behavior" evident. I am now at POTS diagnosis instead (but will tidy up loose ends as I can). My point is that symptoms can be "coincidentally" similar!

I think they have to look at the overall pattern of symptoms as well as hunt the little bugger down visually. One thing I read about pheo's is that sometimes a certain physical pressure on the thing can trigger it to release it's catecholamines. I don't know for sure, but I suspect they also tend to sit there and release a steady stream in other cases/times... which means it looks just like H-POTS in that sense. Someone mentioned a clonodine-suppression-test recently (I think looking for pheo?) which is a trademark sign. The pheo is a hormone secreting tumor (usually benign) that doesn't listen to the body's feedback mechansims... hence skewing everything badly. So if something like clonodine doesn't do it's normal thing, it can be a clue. Clonodine would normally inhibit norepinephrine release from the sympathetic nerves... but a pheo won't listen to that signal and will keep doing it's thing, defying the expected temporary suppression. Whether or not you have a pheo, having a condition that "looks like a pheo" might guide treatment. Avoiding just a beta blocker, opting instead for a mixed alpha & beta blockade (if you do have a pheo, using only beta blockade is considered hazardous); Considering clonodine or similar; Observing and considering more BP increases than decreases. Like the H-POTS stuff. If your pattern is more consistently "orthostatic" then it leans more toward H-POTS and away from pheo. If it's steady or random, then pheo or mast cell trouble might look more likely. But unfortunately, even "just POTS" can cause trouble that is not always timed with "standing"... so nothing is cut & dried. There are other hormone secreting tumor possibilities as well, but they are incredibly (rare) and I think other signs would have popped up to catch someone's eye. I suspect it's gonna take an expert or two and maybe more testing, as opposed to a clear "lab result" interpretation.

Organs like the adrenals are said to have their own internal clocks. One research article I read indicated that even after experimentally cutting it off from outside cues... it kept it's approx 24 hr. cycle going. I personally get "echoes" of many of the extreme "body panic" episodes. I also find that if I exercise at a certain time of day, my body will "rev up" that same time on subsequent days (regardless of my doing anything). These things aren't "solid established science" or anything... but the experimental research & theories fit nicely with my personal experience so I pretty much buy it. I also have a personal theory that when the external cues to these vital organs are mixed up (a.k.a. in context of dysautonomia)... it makes sense that whatever internal clock mechanism is in play will be disrupted in some way or another... muted, flipped, randomized, exaggerated, reverting to some basic "preset"... who knows what. I just know that things get very disrupted and this cascades & feeds back into the initial autonomic problem and perpetuates everything. That's my personal take on it. Organs with too much reverb! +++ Maybe a better analogy is those TV interviews over a slow satellite link halfway around the world... what is supposed to be a quick coherent conversation becomes a jumbled stumbling mess unless both sides are very experienced, aware, consistently timed, and polite. But my body isn't polite to me at times +++ This can possibly fit the pattern of "coming out of the blue"... yet also being from some remote isolated or cumulative cause.

When they aren't from some other "conventional cause" (drugs, dehydration, hormones, etc.), and they stick around a while then OH & NMH are definitely considered forms of Dysautonomia.Some docs insist that there "be no OH" for a diagnosis of POTS, while others allow or even expect it! The dispute here is that OH causes "compensatory tachycardia" because the heart speeds up to make up for the drop in BP... so if you have OH then the tachycardia has a convenient "explanation" and one needn't look further (to POTS). I don't know how important this quibble is. It could be a clue as to what underlying causes are more or less suspect perhaps? The overall "symptom clusters" and common treatments initially tried are pretty similar for POTS & OH... with partial exception to beta blockers (since those tend to bring hypotension and especially OH). For both, the treatments are very "trial & error". I guess, technically, there are 1 or 2 drugs "on label" for OH... whereas "POTS" is "off label". Not sure how much that matters. Does this affect insurance reimbursement for those that go that route??? I don't know. I might be a somewhat similar case to yours. I was first observed with OH and diagnosis leaned that way. Then with just fludro, salt, water the OH is gone (and it comes & goes on it's own anyway) yet my pulse increase is still more than enough for POTS... so a POTS specialist did make the judgment call of POTS for me (and opened the door to BB meds and more). As to whether to continue high salt & water along with fludro. This will vary for folks. Some folks get enough salt via regular food intake for the fludro to have enhanced effect... others need extra salt/water on top of the fludro. Just have to fine tune each. I actually get similar effect from just salt/water therapy compared to 50mcg/0.05mg fludro and my normal intake. I am one of those folks who does get too much effect from going heavy on both at the same time. One should generally monitor BP regularly in case it goes up too much and also look for "edema" (and obviously seek counsel from your doc for full list of concerns). A second consideration is the fact that fludrocortisone is mimicking aldosterone and the body typically produces way more aldosterone when upright than when supine. As you improve and spend more time upright... your body might/should then need less of the fludro, salt, water therapy. This is also the case for me. When I have a "good run" and am up and about more than normal... my BP then gets slightly high (150/160 systolic) and I taper stuff off. A third consideration is that several other things can boost BP. NSAIDs like ibuprofen are one. Of course, caffeine sorts of things do this to "mixed effect" (short term increase, but potential long term decrease from extended constriction & dehydration tendency). Cold meds (especially phelylephrine & pseudoeffedrine) are similar players (constrictors). I just watch for any big or extended trends. I suppose your doc might have more specific advice (like actual good target BP ranges for you)... but actually this is fuzzy stuff to begin with so don't be surprised if they skirt that topic!

Did you have a chance to float the PDE5 (Viagra, Cialis) idea that Firewatcher mentioned before? There is research on that specifically for Raynaud's. I've wondered about Vinpocetine (PDE1 I think). These all modulate dilation so they're in the same boat as other stuff but you never know. I think there are 21 PDE subtypes now, though most are not very selective. I wanted to get this topic to that CFS "Blood Flow" teleconference guy but I fell asleep quicker than expected while signing up and missed the conference! Some obscure ones are scoped out for some surprising "regulatory" effects at least based on research & patent filings (which are very speculative of course . One can hope for spinoff from that as a future insight to flow regulation things since it seems so central to all this. Plus I suppose there are more things like "Substance P" and NMDA neuroregulation and other more mysterious messengers that might open doors some day. Do aspirin or NSAIDs have anything to do with Renaud's (good or bad)? Like via the prostoglandin (dilation/constriction) stuff? Histamine and kinins are constrictor/dilators too. Do those "mast cell stabilizers" do any stabilizing for folks that may not have MCAD or Masto? It seems like anything that brings stability to the dilation/constriction responses could be beneficial. I guess with denervation out there, the other signals can hit "unopposed" at times and swing to some radical extremes.

Am I interpreting this correctly that this symptom hits you whether or not you are exerting your legs. In other words, when on a tilt table where they strap you and avoid your having to exert... you still get the same response. If so, then it seems specifically "orthostatic" as opposed to "exertional".A further distinction (beyond tilt) would be "Lower Body Negative Pressure Test"... where you don't even get tilted (therefore, gravity pressing on a nerve/tumor or whatever concern along those lines should not be involved). LBNP is said to replicate the cardiac circumstance of "standing against gravity" without other change... so far as I know. I've read of its use somewhere... if anywhere, it would be Vandy I'd think.

What symptom(s) has it helped with?

The only "heart drug" I've taken (other than caffeine... he he), is propranolol so I've got pretty much no experience in these realms. I don't know what would help and I'm hesitant to say much of anything since heart stuff is so complicated and important to be cautious with, which I'm sure everyone here understands. From scrounging drug information, it does seem like nebivolol (Bystolic) seems at least partially similar to carvedilol. Can't think of why it would work any better (seems more likely to be less effective on alpha-block lines). Nonetheless, it is something similar yet different if you get to the point of needing to change/experiment. Bystolic is said to have some nitric oxide impact, like carvedilol, so it's similar in that way which might have been part of the objective. Clonodine is a pretty direct opposition to norepinephrine release and something I hope to trial some day. Typically it would concern a doc due to OH in a general population but with H-POTS this can be different or worth it for some folks, I guess. If going "way out 'da box" maybe there are CNS meds out there (which tend to be psych meds since that's "central") that could have indirect (read "side effect") that ended up being beneficial. There is an old neuroleptic/hypertension drug, for example, that works by "depleting catecholamines"... but one is going more "off the reservation" than "off label" there It seems feasible that so long as dilation is steady & consistent, then blood volume can adapt to given "available space" and OI needn't be imminent... though perhaps hypertension is more likely. Maybe this means an ultra-extended release, or ultra-frequent but tiny dosing schedule could help? Sorry. Not much to add (just some babble). Trying to throw some brainstorming out there into the void (and give the topic a "bump"). Have you or the doc come up with anything since first posting this question?

http://www.cybercrime.gov/reporting.htm http://www.ic3.gov/default.aspx If this hacker is stupid enough to do that, then a skilled person might be able to provoke the response again under controlled circumstance and document specifics or glean more info as to who/where they are. Not always fruitful, but worth a shot.

"Whats Going On With My Mitral Valve?" Indeed. That was my favorite Judy Blume novel as a yute. It does sound like an advanced question and also a subtle clue. I agree, it seems like stepping this up to a cardio or two is best. Maybe taking a look-see with ultrasound or the doppler thing can show some evidence of a development? Seems like a GP should refer this out without much resistance (or have done so already). Maybe there is something better to be done eventually other than just more of the existing med?

I was cautious to aim for "mild chuckles" or less... especially in lieu of the recent post about laughter making people more sick. I apologize if anyone suffered an inadvertent belly laugh, incontinence, or spitalemesis. Definitely not likely with the above modest material... but you never know. I always laugh hardest at the lamest jokes for some reason... and any excuse to say "foolio" is always welcome Yeah, I get that a lot. I do got some mad autonomic game... ithankyou. I have to be careful how I use it... especially amongst ladies who's hearts flutter & sputter so easily.

I've got the "non-restorative sleep" or whatever it's called, which seems so common with dysautonomias. I almost wonder if that is "a given" with us. I can literally remember just a few days when I woke up feeling truly "rested and bright" (which lasts a few hours when it happens)... other than stretching back to childhood memories. I've had bouts of overt sleep disruption (waking in panic/terror, myoclonic jerks, insomnia, stuck in tired-but-wired mode, etc.) that are definitely improved with better autonomic management... but "restful sleep" or "wakeful feeling" remain elusive (except during panic/terror modes ).

Sounds like a "derealization" style panic attack (some folks "categorize" them). Ironic in a way since "panic" is a "heightened alertness" state yet it can drive the mind into an utterly-disconnected corner. But that makes perfect sense too (like a derealization/depersonalization response to trauma). It also makes sense when there is no possible response... when one is utterly trapped (I hate the "smothering" panic feeling too . Physiologically one is being driven about as hard as you can be toward action yet none is appropriate (except road rage perhaps . Inhibition to this onslaught of "fight or flight drive" needs to match the intensity... which means total "root" disconnection in my book (and experience). Otherwise, I guess something could snap... which is of course one of the other classic "panic attack" sensation of "intense fear of loss of control or going crazy". Personally, I suspect this is the harder sort of panic to get relief from (compared to "racing heart", "sweating", etc.). It is also the most similar sounding to the partial-seizure and migraine-aura sorts of things (and maybe this is due to affected brain regions, who knows). Experience it chronically enough and you might join me in a chronically "derealized" state (please don't... docs don't have a cure). Not sure what can prevent it best, but certainly do all you can with basics of managing dysautonomia, stresses, etc. Maybe do the leg pumping exercises to keep blood flowing (without hitting your gas pedal of course... unless you're in a Toyota, in which case you have a legal "excuse" should anything happen)... whatever you can do while sitting. Maybe pull over prior to this spot and do some jumping jacks so you're blood is pumping prior to this risky potential stopping point? If this is a "body panic" then for some folks, a limited amount of "good stress" can avert the "bad panic stress" as the body stalls. If you are timing meds to avoid being sedated while driving, maybe they're worn off at a bad time and this is contributing? Also, this will not stop the problem and it comes off "condescending", but they say to emphasize to yourself that the intense fears "aren't real" and "will pass" since this might at least prevent further escalation. If all else fails, and I don't wish this for anyone, but you might eventually get to the point of being able to have full blown "panic attack", be "totally off in space inside" and still carry on a conversation where other folks wouldn't even know what's up... or with just the appearance of "freezing up" a little bit as far as others observe. I think some of us survive that way as a last resort if not fortunate enough to have better relief. One can "get by" one way or another. I'm just babbling from my perspective. I expect lots of this might not fit you or many others. Just draw whatever you see fit.

Sure enjoy mystery diagnosis. Many episodes end up at ultra-rare conditions but "OI" is one of the few they've covered that isn't... thankfully (thankful they covered it, not thankful it is common, of course . This show is generally like a "workshop" in the "other 0.1%" of possibilities when dealing with "non-specific symptoms". That's the running theme, really. I love their "wrapup pivot segue quote" so much that I've taken it on as my "signature" for now At one point I was tempted to visit my doc wearing a "House, MD" T-Shirt, present a transcript of "Mystery Diagnosis", a series of printouts from "Internet Health Searches", insist that he read a collection of research articles, and recite a few home blood-pressure-meter logs and my list of "non-specific symptoms". I think I would have ended up in their scrapbook photo collection of "walk-in hypocondriacs" hall-of-fame (posted in the doctor's lounge like the "employee of the month" photo in a fast food joint). Ironically, it was these exact things that assisted me... along with my doc being young, open minded, and genuinely a nice guy and the fact that I'm operating within an HSA so I'm stewarding my own health (not as hindered by an insurance interest or government or a need for C.Y.A. "defensive medicine" to road-block and bury me with expenses). Well, it was everything above except wearing a "House" T-Shirt... I skipped that part. I now have official diagnosis from my doc and a EP cardio with dysautonomia expertise (formerly of Mayo MN).

Option #2 is probably close enough in this case. "Up fast, meander down." or thereabouts. Yeah, they do say normal folks can have that initial jump... however it seems clear that this is due to your meds helping (and maybe even some healing if lucky I hope the doc used wise overall judgment of the whole picture in your case and made the diagnosis... otherwise sans meds and in a solid flair would do the trick, I'm sure!I have a mixed situation too. Have bouts of OH, not to mention the NMH-like thing (or delayed OH) after 10-15 minutes which may or may not count, and then the bradycardia which can itself contribute fatigue and such! I could end up with a label of OH, POTS, OI, NMH, CFS-P, whatever combo. Perhaps OI or just "dysautonomia" (which my doc now uses) covers it all anyway. My diagnosis for POTS was actually helped by being on fludro, which although it blunted my HR (since part of that is from a compensation for BP drop), it demonstrated that there was still plenty of HR increase left over to qualify! Treatment is still pretty similar so I'm not worried about exact labels. For all I know, I might just have a psychogenic condition like PTSD with unusually bad physical presentation (HPA axis distortion)! I gave up caring about labels or implications and just figure finding something that helps is a step in the right direction! Thank you all for your answers.

My record awake & supine is 33. A normal supine low is more like 38 or 40 (same sleeping & awake... perhaps because rarely feel like I'm awake at all! . Standing will be 90 to 120, instantly depending on med & body state. NuVigil seemed to get me into the 50/60's while supine. Things like caffeine and/or pseudoeffedrine can help me with this too. I was unable to talk my doc into trying isuprel rather than my albuterol (since isuprel is non-selective and is one of the few drug treatments for brady) but I'm curious about that. For now, maybe with a concoction of various B vites, lotsa choline, and very steady Na,K,Mg dose I may have mitigated my bradycardia though. Will have to see if it holds up or is a fluke. More recent than that, Klonopin might be helping... despite being a "depressant" it might be stabilizing response for me, I guess it can do so for some folks. An extended rest period didn't make my brady go away, so I don't credit simple exercise. Taking that break set me back significantly in stamina, POTS symptoms, everything. Even if some exercise is dropping my HR a few beats, and causes blowback, I stick with it as best I can. Unfortunately with dysautonomia they say it's not uncommon to have variation in either/both directions of HR, BP, etc. Something hormonal like Addison's or hypopituitarism could also create brady with simultaneous orthostatic hypotension & tachy... so good to keep in the back of one's mind. Given the ANS intertwining with everything else I wouldn't be surprised some of the mechanisms are shared a little too. +++ Oh yeah, consider other brady sources too, like apnea, hypothyroid, hypoglycemia, etc. +++

What I'm wondering is if an "instant" response like this might be more likely related to "baroreflex" trouble, NET deficiency, specific style of denervation, etc. as opposed to a "slower pooling" that drives a person orthostatically hypovolemic (with compensatory HR response). Or maybe "pooling" can happen instantly too, I don't know, just looking for any trends or associations here. A little detail (not necessary if just interested in the poll, feel free to skip): In "the literature", it seems that POTS can involve a slow steady rise beyond the supine + 30bpm level and/or 120bpm. In my case, my HR adjusts instantaneously, as in within a few seconds. If coming from bradycardia, my pulse will double or even triple instantly (40 --> 120 in a few seconds isn't unheard of for me, but rarely over 120 so no severe tachy). It almost makes me think of some arrhythmia where the sinus fires twice all of a sudden (or was firing only half when I am bradycardic) rather than a steady "ramping up" of sympathetic activity rate or hormone release... but that's another topic unless it rings a bell for any of you. When I lay back down (from poor man's torture test)... my HR is again instantaneously slower (in fact slower than the initial supine value for a few minutes, which I think is quite normal since a slow acting response was probably fighting the tachycardia).

I bumped into one article that mentioned a "known murmur condition" (presumed to be benign). Not sure of the source/validity of this tidbit, but could this have been MVP which comes up in the dysautonomia world (and is semi-synonymous with POTS)? If it happened to be "MVPS" then that seems like tacit indication of dysautonomia (POTS). Or just PVC's which also seem so common amongst us??? Not sure if the those make a murmur though. On another angle, Hypertrophic CardioMyopathy can create a murmur. HCM can be considered benign in some cases such as mere/positive exercise adaptation... yet it is also associated statistically with sudden cardiac failure (as in young otherwise fit athletes). I apologize for the speculating here. I hope it is taken in the spirit of understanding better what may have happened... rather than anything like a "tabloid" or "random rude blog comment" as happens elsewhere. I'm just brainstorming as to other things that might confirm the sense that docs missed a dysautonomia diagnosis along the way.

I did an extended intentional deconditioning period at one point. Figured it was necessary to give a "good faith" investigation into whether my bradycardia is from being "in such good shape" (simultaneous with my POTS/tachycardia being from severe deconditioning, of course . Needless to say, it set me back tremendously. My resting HR might have gone up a few beats but not much. For me, even minimal maintenance exercise amid bad periods and even things that backfire badly seem to be a plus in the big picture... but it's a tough call. I "self-prescribed" this deconditioning, so no blame on a doc or anything. Was just part of learning about my body the hard way. It was maybe a year ago, and I don't think I've regained stamina I had back then yet (but other factors are always in play too). I've been perplexed by the "medical stereotype" of POTS/dysautonomia being "thin women". I can see how digestive troubles could promote that, perhaps norepinephrine surges helping burn stuff off... but for those of us with extensive fatigue and difficulty losing weight (from inactivity and/or lower level issues) it seems surprising. I can definitely see how going too thin can be fatiguing & debilitating too, perhaps more than being hefty: Maybe Fat-POTS and Skinny-POTS (F-POTS vs. S-POTS) would be a more useful schism than H-POTS and PD-POTS??? Might trace to some specific ANS influenced metabolic distinctions that are as meaningful as a nanogram/milliliter of norepi! Who knows, maybe the beta-adrenergic receptors that release fat energy get desensitized from chronic stimulation in select folks??? NIH, may I have a couple mil to study this please?

Not sure if holter is always a short duration thing or not. If so, there are the longer monitoring dealios where you keep the thing on for weeks and "press a button" (remote trigger) to capture things right around the time you experience symptoms (sometimes "phone in" samples too). I would definitely mention that Mg was one of the things that triggered your response, especially since some folks get relief from arrythmias with Mg supplementation. Might be a clue for a bright cardio. I also wonder about two other things: a) If something else is out of balance (such as a hormonal thing, thyroid, et. al.), then other "systems" in the body can get very finicky even if they aren't the real source of the trouble. An intermittent heart trouble and extra sensitivities might mean the heart is "on edge" since something totally different is slightly out of range. Then again, living "slightly out of range" is what dysautonomia is all about, isn't it?!? Are there things that mimic heart sensations that might get involved? I know I get this "lung overpressure" thing that is like a heart/lung interaction but might never show up in electrocardiographic measure. It might be a blood flow irregularity, I don't know. I've heard of such things, particularly with other organs. Can give weird feedback/sensation to heart if blood is diverted unusually or suddenly. There could also be something "spasmodic" somewhere that could either be related or unrelated to heart but cause sensation timed with it. I think some of the heart sensitivities you've described were after eating something, so maybe digestive processes tie in. Sometimes the body "releases something" on demand to digest/absorb/transport/excrete certain things. This might happen pretty quickly in some cases. It also might count as an autonomic response and if something is confused or blurred there, seems like a way that one "legitimate signal & response" can cascade into a "dysregulated" response elsewhere (and the darn "disperse & migrating symptoms" that dysautonomia tends to cause). I wouldn't know anything specific... but then again, top of the line autonomic specialists usually can't state too many specifics either! c) A bonus/side consideration that stuck in my head after reading that Stromboli MS theory a while back. There was mention of transient blood brain barrier disruption. Things like MSG are not observed to traverse the barrier (general rule is being lipophobic & lacking an explicit transporter)... but what if a condition exists where the BBB isn't behaving as cut-n-dried as science & statistics tell us? That article seemed to imply the possibility. Perhaps other innocuous agents that never touch 99.9% of folks can do so in a select few. This is just a side thought because it has more to do with a "multiple chemical sensitivities" thing, than with something more specific like palpitation. I get plenty of variation in how my heart feels. One of the more odd ones involves what I'm guessing is a positive inotropic response. When it comes on suddenly it is alarming, feels unnatural, etc. but can actually be a benefit to flow! The odd thing is that I get it at odd times (and rarely). Seems like something that should happen more often, like when exercising. Makes me wonder if my heart is operating in an odd realm so chronically (perhaps making up for a lack of inotropic force with futile chronotropic response, a.k.a. tachycardia), that a rare glimpse of a normal response can seem like a malfunction! After years of dysfunction, a bit or normalcy could be a very foreign sensation. At the end of all that... perhaps electrophysioligical measure isn't always the whole story either. Echocardiogram, CT, X-ray, and fancy "doppler" techniques might catch something too (not to mention invasive flow studies). Submitting to "provocative tests" like administration of drugs that induce specific heart responses, can be an option too. Things like "long-QT" which "ought to be obvious" on an EKG can also go unmeasured even under strict scrutiny. All tests have false negs & false positives and the most reliable instrument is your personal observation & intuition. Don't let the technology (and doctor ego) dissuade you of that.

A trickle of minerals through the day is probably the way to go anyway rather than large doses that get excreted immediately. I like Squirt so I might give this a try. I just hope they don't abuse these Pocari in the process of collecting the sweat. Hopefully they're the kind of animal that likes a good workout.