It feels like we’ve officially reached the next layer of this very long cardiovascular detective story.

I recently updated my cardiology team because, even with my Lopressor increased to 50 mg three times a day, I am still having breakthrough episodes where both my heart rate and blood pressure climb with standing and even very light activity. The pattern has become frustratingly consistent: if I am seated or lying down, things tend to settle. However, once I’ve been standing for around ten minutes or longer, my numbers often start climbing again.

And when I say “activity,” I do not mean exercise. I mean putting my hair up, taking the dogs outside, cooking dinner, doing dishes, folding laundry, standing at the counter, and all the other tiny daily things most people never think twice about. Light movement that should not feel like cardio somehow sends my heart rate into the 90s, 100s, and sometimes higher. There have also been breakthrough spikes even while sitting, which is part of what prompted me to reach back out to cardiology.

My message to them included some of the numbers I have been tracking, including a heart rate that jumped to around 130 while I was simply putting my hair up, a seated blood pressure of 146/96, and seated heart rate spikes over 100.

Their response was that Dr. Val has now referred me to an electrophysiologist.

That is a significant next step.

An electrophysiologist is a cardiologist who specializes specifically in the heart’s electrical system and abnormal rhythms. While my current working picture includes IST and dysautonomia-type symptoms, this referral means we are moving beyond simply documenting that my heart rate is high. The next question is much more specific: What exactly is my heart doing when these episodes happen, and why?

The goal now is to better understand whether these episodes are entirely consistent with IST and autonomic dysfunction, whether there is another rhythm issue layered on top of that, and what treatment options make the most sense from here.

One possibility that is very much on the table is a loop recorder. This is not just something I stumbled across while reading about possible tests. Dr. Val has already mentioned a loop recorder to me twice, so it is a real possibility in my case.

A loop recorder is a very small device placed under the skin of the chest that continuously monitors the heart’s rhythm over a much longer period than a standard office ECG or short-term Holter monitor. That can be especially helpful when symptoms are intermittent, unpredictable, or difficult to catch during a limited monitoring window. Considering how inconsistent these episodes can be from hour to hour, that makes a lot of sense.

There are also other testing possibilities that an electrophysiologist may consider depending on what they see in my history, current monitoring, symptoms, and response to medication. That could include additional rhythm monitoring, stress testing, imaging, or possibly an electrophysiology study in the EP or cath lab.

During an EP study, catheters are guided through blood vessels into the heart so the electrical activity can be mapped from the inside. In some cases, the team may intentionally try to trigger an abnormal rhythm in a controlled environment to see where it starts and how the heart responds. That kind of testing can help determine whether a rhythm might respond to medication changes, whether something like ablation could ever be appropriate, or whether the problem is more autonomic than electrical.

None of that is confirmed yet. The electrophysiologist may decide that additional monitoring is the best first step. They may decide the loop recorder makes the most sense. They may recommend something completely different. I am trying not to get ahead of the process, but I also want to understand what the next phase could look like.

For now, I am still doing what I have been doing for months: tracking everything. Heart rate, blood pressure, symptoms, standing versus sitting, activity level, medication timing, sleep, dizziness, chest pain, internal tremors, near-falls, and how long I can stand before my body decides standing is apparently an extreme sport.

The most consistent pattern continues to be that prolonged standing and light daily activity can cause disproportionate increases in my heart rate and blood pressure, while sitting or lying down tends to bring them back toward baseline. Some days are better than others. Some days I can do household tasks with only moderate spikes. Other days, twenty minutes of standing while cooking leaves me dizzy enough that I have to catch myself before I fall.

That is why this referral matters. We are no longer just asking whether my heart rate is elevated. We are asking what rhythm is actually happening during these episodes, what is driving the response, why standing and light movement trigger it so strongly, how much of this is autonomic, and what can be done to make daily life more manageable.

I am relieved that the process is moving forward, even if I do not know what the next answer will be yet. At this point, I feel like I need a firmware update for my body or something, because apparently standing, making coffee, doing dishes, and existing upright are all advanced system operations now.

For now, I wait for the electrophysiology appointment, keep collecting the evidence, and keep listening to a body that has become extremely committed to producing plot twists. One step at a time. 💜🫀

Much love and many blessings,
Mrs. B