Symptomatic palpitations

Hi Everyone--

I'm looking for some advice and information since it seems like my cardiologist is both confused and treating me like I'm some head case.  I had POTS (postural orthostatic tachycardia syndrome). That was pretty well controlled by a beta blocker though for years. Recently though, I've been having palpitations. They seem to be of two kinds. One feels like butterflies in my chest--and sometimes when it's bad it feels horrible. That is often accompanied by wheezing, tiredness, and lightheadedness. It occurs more frequently when it is hot out. It comes and goes, but is brought on by activity: riding my bike, climbing stairs, vacuuming, trying to open a stuck window, shoveling snow.  

The other feeling I have is skipped beats and just a feeling of my heart beat being all over the place. I went to the ER for that the first time it happened about six months ago and they said I was have PACs. It usually gets worse as the day wears on and is especially bad when I lie down at night. When it's really bad, I also get that wheezy, congested feeling in my lungs.  If I try to talk I just cough.  Sometimes I wake up in the middle of the night and my heart is going so fast I can't get a pulse, but I estimate it's been up to about 300 bpm. That doesn't last very long though once I wake up.  I did a stress test and had an S-T segment depression so my cardiologist ordered a Cardiolite stress test. I was worried about the radiation, so decided to go see a POT doc first to see if that might be the issue. Did autonomic testing and that--to my surprise--came back fine! Went back to the cardiologist today and I felt totally blown off. It was really weird. My pulse was 96 and irregular, my bp was 125/90 (the 90 is high for me) and I was just feeling really weird. My thinking seems to slow down and my talking too when this happens. My palms were sweaty--and that is strange for me. The doc tells me that PACs are normal. How many are normal, I ask. "I don't have an answer to that, but your heart is fine structurally." Uh, yeah, I get that--minus the very minor leaky tricuspid valve.  He tells me to we're going to up the does of beta-blocker. Okay. Then I ask him about the Cardiolite stress test that he had ordered earlier, but I haven't done yet. "You don't need one. We'd do a stress test first anyway."  Dude--I'm thinking--read my chart. I tell him that I already had one and I tell him the results. He goes into a spiel about how 30% of women have false positives. I say, okay, fine, but I'm thinking, then why did you order one earlier? If anything I'm worse now.  I don't really want to do a Cardiolite, so that's fine, but I feel like this guy a) doesn't read my chart; b) isn't up on the latest literature (too many PACs are predictive for afib later); c) didn't take me seriously. He listened to my heart and didn't say anything. So I asked him what he heard. He says, nonchalantly, "Well, I heard a couple of skipped beats." He did order a 30 day monitor though, so maybe we'll see something.  Anyway, I'd love some feedback. What am I feeling? Are they just a lot of PACs?  I could hardly carry on a conversation for a while today it was so bad. A couple of times I've found it hard to keep my eyes in focus. I don't want to be ridiculous, but I also don't think this is just a couple of normal PACs. Oh, and every once in a while I do feel chest pressure or more rarely chest pain, but it doesn't last long. The first time, when I went to the ER, my neck was also kind of sore as was my throat. Not bad, just a little.

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