** Thanks for contacting HCM with your health concern 1. As you have taken an opinion of Cardiologist thus he must have evaluated your health condition thoroughly but if blood pressure is still fluctuating with palpitations then one condition to exclude is Pheochromocytoma [tumor pf the adrenal gland] for which Ultrasonography is ideal 2. Other possibilities to rule out is/are: . Deposition of Cholesterol [Atherosclerosis] causing Arteriosclerosis which makes arteries stiff and inelastic resulting in systolic hypertension causing blood pressure difference. . Overactive thyroid, Acute stress reaction, anxiety disorder, overexertion, excess use of caffeine,alcohol,diet pills . Fluctuating blood pressure is often associated with high risk of stroke, heart attack,kidney failure,heart failure and premature death thus lifestyle changes [stop smoking/avoid alcohol,exercise regularly,breathing exercises and meditation [stress reliever], along with medications prescribed by your attending physician are important for successful long time treatment. 3. An evaluation in emergency room will not reveal any rhythm problem because the evaluation is done at rest, and more detailed evaluation will require TMT [tread mill test] and ECG [echocardiogram] to assess the health status of heart muscles and valves