A Nervous Heart
A 42-year-old man was referred to our Hypertension Center for increasing episodes of tachycardia and elevated blood pressure (BP) readings. Over the past 3 years, he had been progressively experiencing frequent and worsening episodes characterized by palpitations, chest discomfort, and tremors, symptoms that the patient referred to as “a nervous heart.” These spells would only last a few minutes most of the time, sometimes completely resolving after 1 hour. On a few occasions, BP readings were elevated above 200/110 mm Hg. Multiple studies and tests performed at different medical centers, including plasma creatinine, thyroid hormones, aldosterone levels, rennin activity, and plasma fractionated metanephrines, were all normal. Full-body computed tomography scan and magnetic resonance imaging, renal artery duplex studies, electrocardiogram, transthoracic echocardiogram, and stress echo studies were also all unremarkable.
On presenting to our clinic, his resting heart …