Question: Hi, I'm looking for a second opinion. I'm a 45 year old male that has been diagnosed with vasovagal attacks. I've never fainted during an attack, so I suppose that when I was diagnosed, the doctor thought I had pre-syncope. My symptoms started a year ago. I experienced without warning approximately 20 episodes of tachycardia (160-180 bpm) concurrent with light headedness, nonspecific chest pain and an adrenaline type rush in a 3 month window from April to XXXXXXX 2013. At times, these episodes appeared to be related to some physical event - they would happen an hour or so after a heavy meal, or they would happen approximately ten minutes after laying down to sleep at night. Sometimes, just preceding these episodes my vision would become blurred with a kind of milky white substance that would clear with persitent blinking. Unspecific to these episodes, I also started experiencing very itchy eyes, tingling sensations in my hands and feet, and when standing up, urinating, or even just sitting up in bed I often experienced palpitations (felt in my neck) , a blood rush to and pressure in my head - I also could hear a rumbling noise in my ears sometimes at night when lying down to go to sleep. Lastly, again unspecific to these episodes I also experienced persistent light headedness, breathing difficulties (almost feels like my breathing is too shallow - however I don't preceive that my breathing pattern itself has changed, it doesn't seem to me like I'm hyperventillating), felt a little short of breath, and was constantly having to clear my throat. The interval between the attacks of tachycardia gradually increased and seem to have all but dissappeared now, however I still get maybe once a week a strange feeling (slight pressure) in the centre of my chest but no associated tachycardia. I have been tested for pheochromocytoma multiple times with negative results, I have also had a PET scan which did not reveal any evidence of Carcinoid or Pheochromocytoma. I have also had 2 sleep studies which did not show sleep apnea (my sleeping partner does however tell me that she has noticed that I stop breathing in my sleep sometimes). 4 weeks ago I had a 1cm hamartoma removed via resection of my lower left lung. Now, however, the persistent symptoms that remain from my first attack a year ago are: 1. occasional strange feelings in the centre of my chest (slight pressure) 2. slight adrenaline type rushes not followed by tachycardia 3. TIngling hands and feet ( whilst sitting - happens multiple times per day) 4. Lightheadedness - slight head pressure 5. Breathing difficulties persist - I don't feel quite satisfied 6. Constantly having to clear my throat 7. Blood rush to head when standing up from sitting or when sitting up from supine position 8. Palpitations whilst urinating (I feel them in my neck) - approx 50% of the times that I urinating I am overweight, I weigh 96kg and am 180cm in height. I am usually fairly active, walk on average 5km a day. I am currently taking 5mg of Corolan (prescribed by my cardiologist) once every two days. When I am not taking Corolan my regular heart rate (sitting) is approx 90 bpm and my light headedness symptom returns, when I am taking Corolan my regular heart rate is approx 65 bpm and the light headedness is much less. Last year I had an echocardiogram which did not show any problems, I also had a stress test which showed my heart health at 105% of my age. I have also had a holter monitor and event monitor - both showed no SVT, however one did capture a tachycardia event but showed that it was a normal sinus rythym. I am not satified with the diagnosis of vasovagal attacks because: 1. My persistent symptoms do not relate to specific episodes 2. From my research I cannot find many of my symptoms attributed to vasovagal attacks If someone could suggest an alternative opinion I would be very grateful for you thoughts. Ideally I would like a suggestion as to what tests might be perfomed to assist in a deterministic diagnosis.