mclark

Hello. I am a patient at Mayo Clinic and am having trouble receiving a diagnosis. I have completed an autonomic reflex study, including a tilt-table test This showed "excessive heart rate" (max heart rate 124, BP 104/78) over the course of 10-minutes. The test also revealed sudomotor impairment w/preserved cardiovagal and adrenergic function. My PCP then order catecholamine testing which showed supine norephinephrine levels of 327pg/ml and standing levels of 1066pg/ml. My 24-hour urine test had a total volume of 1224ml and a 24hr sodium concentration of 53mmol/24 hour. My PCP has stated that all test are normal w/the exception of the elevation in HR. My symptoms started over a month ago. They include tachycardia, headaches, seeing spots, near syncope, palpitations, chest pain, tremors, "brain fog", extreme fatigue and insomnia. Additionally, one of my near-syncopal episodes resulted in a code-blue while at work. I was sent home with a Holter monitor - which showed a max HR of >140, an average HR of 98, and a min HR of 82 at ~3am (when I was sleeping). No arrhythmias were noted (other than an occasional PVC). Sinus rhythm/sinus tachycardia were shown throughout the 24-hour period. I am curious if anyone is aware if Mayo has changed their laboratory standards. It is my understanding that a standing norephinpherine level >600pg/ml was considered "abnormal" and a 24-hour sodium level <170mmol is hyponatremic when considering a potential diagnosis for POTS. If anyone has any suggestions or ideas, I would be highly appreciative. Obviously, I do not want to be prematurely diagnosed, and want physicians to do their due diligence. I am simply confused by the inconsistencies between my PCP's interpretations and what I have seen in the literature. Thank you! Melissa