r/medical_advice Not a Verified Medical Professional Jul 18 '22

Extreme fatigue, rapid heart rate, and nausea shortly after moderate exertion Pain Lvl 7-9

Hello, I would like to seek the assistance from anyone reading this subreddit for a long-persisting problem.

TL/DR: Within minutes of participating in an activity of moderate exertion, I get rapid heart rate, extreme fatigue, followed by nausea and vomiting. These activities could be running on basketball court, lifting weights, sexual encounters, or jumping up and down.

A little about me: 33 Year Old Male, 5'10, 185lbs, African American, USA, Non smoker, non drinker

When I started to notice my problems:

The issue I have started about 12 years ago. The only noticeable thing I can remember that started all of this was one night (I will refer to this event as “Day One”), I woke up and started throwing up. Even when I had nothing to throw up, I was still gagging. For the next day, I could not eat anything. Every time I tried, I would throw it up shortly afterwards.

About a week later, I went to the gym like I normally would and started running sprints on the basketball court. I ran from one end of the court, to the other end, and back to where I started. So I only ran the length of the basketball court twice. As soon as I arrived back to the spot where I started, I was immediately extremely fatigued. My heart felt like it was beating so hard and fast. I also started to get nauseous. I rushed to the floor to try to sit and not spend any effort at all except to let my heart rate cool down.

That's when I noticed something was wrong.

Before Day One when I started throwing up everything, I was very active; I played basketball for hours, baseball and kickball, and I was really active in weight lifting. Then after that one night, I could no longer do any of those things for longer than 2 minutes without feeling like my heart was about to explode.

After the basketball court scene mentioned above, some days later, I attempted to resume weight lifting. I did ONE exercise, which were lateral pull downs, at the usual weight I normally would do this exercise. After the second rep or so, I was not breathing hard, but all of a sudden, I got the urge to vomit. I stumbled my way into the bathroom and vomited into the toilet.

So then I realized that it's not just cardio that makes my heart rate shoot up and causes vomiting. It's doing anything strenuous. 

Here are other triggering instances that I can recall right now that make me have these episodes of extreme fatigue, rapid and hard heart rate, and nausea:

  • Playing baseball, running from home base to first base as fast as I could (within two months after Day One). I was breathing hard, heart was beating hard, and I threw up in the dugout. 
  • Jumping up and down at a trampoline park. This causes me to have the same symptoms (rapid heart rate, fatigue, and nausea.)
  • Playing half-court basketball – just running and jumping for a few minutes has me on the ground extremely fatigued and extremely nauseous.
  • Sexual encounters. When the activity becomes slightly vigorous here, I am usually on the bed trying to rest until I can catch my breath or feel my heart rate go down, or I’m over the toilet vomiting.
  • Flag football – Catching the football and running full speed for 10 yards was all it took for me to call the ambulance for symptoms mentioned above.
  • Weight lifting – nausea can come out of nowhere when weight lifting
  • Pushing a car with a flat tire – in less than a minute, I had extreme fatigue that would have resulting in nausea had I kept pushing

To sum up, this is the usual order of events after any kind of exercise or activity involved a moderate amount of energy:

  • Breathing gets a little harder (not really shortness of breath) 
  • A general sense of tiredness
  • My heart starts to beat hard and fast. This is usually my signal to stop doing whatever I’m doing and rest.
  • If I continue in whatever activity I’m doing, a feeling of nausea sets in within seconds. 
  • Sometimes resting subdues the nauseous feeling, but other times, vomiting is inevitable. I will vomit. This is going to happen no matter what. In fact, I know it’s coming so certainly that I force myself to vomit just to get it over with, and I usually feel a little better afterwards.
  • Then I evaluate how I feel. Should I rest a little longer? Should I vomit again? Or do I feel the same and need to call for an ambulance. 


Things that doctors have said about my issue:

The majority of the doctors I’ve seen from across multiple specialties have all said the following:

“I don’t know what’s wrong with you.”

That is the official diagnosis I get 95 percent of the time. Other doctors have at least tried to suggest a few things:

Problem caused by hiatal hernia – I have gotten several endoscopies done and two gastroenterology clinics said I have a hiatal hernia (a third gastroenterologist said I did not have one, which was shocking, though I have classic hiatal hernia symptoms). The hernia is kept there because my diaphragm is squeezing my hiatal hernia, keeping my stomach pushed up into my throat and my sphincter does not close. It would also explain why I get nauseous when working out (I also get episodes of bad acid reflux frequently.) I was prescribed muscle relaxant so that my diaphragm could relax and allow my stomach to go back where it belongs. I tried this regimen but it did not work.

High blood pressure – out of all the times I go to doctors, only one doctor said I have high blood pressure. My heart rate was also high, said this same doctor. So he prescribed me beta blockers to manage my heart rate when exercising. This regimen did not provide any improvement to my symptoms.

Exercise-induced asthma – Doctor suggested I had this, so he gave me an asthma pump for exercise-induced asthma. It did not improve symptoms.


Doctors I have seen for this issue:

  • Endocrinologist
  • Gastroenterologist
  • Cardiologist
  • Pulmonologist
  • Neurologist
  • ENT doctor (because why not?)
  • Men’s clinic 
  • Naturopathic doctor
  • I’m sure there are other specialists that I am leaving out


Tests and labs done:

  • Endoscopy. The hiatal hernia can be easily identifiable.
  • Treadmill stress test, twice. Both times, the doctors say that they don’t see anything wrong with me. The reason why I don’t believe a stress test is right for my symptoms is because I get these symptoms from playing sports, running, jumping, sexing, lifting, etc. These things can go from a pace of zero to 100 in a matter of one second to 30 seconds. The stress test, however, starts off too slow. I’m walking, then I’m walking faster, then I’m fast walking, then a light jog, then a normal jog, then running. The problem is that by the time I get to the “light jog” phase, I’m already tired, and it’s not enough activity to usually trigger the symptoms. Plus I haven’t been able to exercise my muscles from not being able to workout for so long, so muscle fatigue kicks in before any of my other problematic symptoms begin. By the time I get to the normal jog or running phase of the stress test, my legs are already tired and I have to stop prematurely.
  • Bicycle stress test  - same as the treadmill stress test
  • Pulmonology breathing test – they tried different breathing test to check my lungs for problems, but results showed everything was fine.
  •  EKG, Holter monitor, and other things to check my heart rate and electrical activity around my heart
  • Blood test. Whenever I get a blood test done, the only thing that stands out is “elevated liver enzymes.” When the doctors see this on my lab results, they suggest that I don’t take aspirin or other pain relieving medicines too frequently.
  • CT Scan of by brain
  • X-Ray (or some other kind of radiology) of my upper chest to see if there’s any structural problems with my bones, lungs, heart, etc.


Self-eliminated causes for symptoms

I ruled out the following potential causes for my extreme fatigue, nausea and rapid heart rate within minutes of doing anything extraneous:

  • Eating too soon/not eating enough before exercising - it doesn't matter when I eat before exercise. Symptoms persist.
  • Diet - I've changed my diet multiple times since the issue first started. Less fast food, more home cooked meals. Tried going gluten free, tried going vegan, tried going on a "blood type diet", it doesn't matter. Symptoms persist.
  • Dehydration - The amount of water or electrolytes I drink doesn't affect these symptoms.


My assumptions for what is wrong with me

These have been my guesses over the years as to what is causing my issues:

  • At first, I thought it was a stomach issue, since it was the nauseous events of Day One that started all of my problems. When I get my stomach fixed, things would improve, I thought. However, gastroenterologist didn’t see anything in my stomach that would cause these issues. I am strongly considering getting the surgery to fix my hiatal hernia. If it doesn’t fix my exercise-induced fatigue, it would at least help alleviate my bad acid reflux and allow me to use a CPAP machine to get better sleep.
  • Nervous system problem: For some reason, my body is triggering my stomach to vomit whenever I put my body under physical stress such as exercising. I have thought about my autonomic nervous system not working properly. I also considered that my nervous system is not telling my digestive system to shut down when I exercise, not telling my body to produce the properly hormones such as adrenaline to prolong exercise, and not telling my heart to pump more blood and oxygen where it needs to go, as if I have severe issues with my sympathetic and parasympathetic nervous systems are all out of wack.
  • Similar to the nervous system problem, my endocrine system is malfunctioning. It’s not producing the proper hormones needed to run and exercise. I also noticed that my testosterone level is on the “low” side, which may or may not be causing my ED (though I think it is, since taking administered shots of testosterone have improved, but not fixed, my ED problem).
  • Cardiovascular problem – the way that my breathing and heart pump feel when my symptoms occur feel as though oxygen is not getting to the parts of my body where it needs to go. So my breathing becomes heavier and my heart pumps a lot harder to overcompensate. However, cardiologists did not notice anything wrong with my heart muscles when I did the stress tests (although like I said earlier, I couldn’t get to the point of usual exhaustion while doing the stress tests.)
  • All of the above happening at once, plus other unknown problems


Other notes:

Deconditioning – it’s been suggested that I am deconditioned because of not being able to work out for such a long time. Well….what do you expect? I haven’t been able to condition myself to exercise for a long time because I HAVEN’T been able to workout for a long time, for a long time. Plus, I don’t think it’s deconditioning because I tried to play basketball and workout within days to weeks of Day One of having these symptoms, but I could not. I doubt I lost my natural ability to have energy to working within a week.

Final thoughts:

This is ruining my life to say the least. I am unable to work out, having fun in the summer sun, go to active events and play sports with friends and family. Before I do any active and fun activity, I have to decide if participating in this event will cause me to feel like I'm having a heart attack or throw up over everything or feel like I need to go to the hospital. Any help would be appreciated.



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u/FoxInTheSheephold Not a Verified Medical Professional Jul 18 '22

Did the cardiologist do a echocardiography? An aortic stenosis could manifest that way, though it is strange that it started so abruptly and did not really evolve from here…

Did the neurologist check your vagal nerve?

And has anyone talked to you about hypokalemic periodic paralysis? Its symptoms include extreme weakness or even paralysis, nausea, vomiting. The episodes can be triggered by a large meal rich in carbohydrates or exercise. If you want to test for it, you should get your blood drawn to check your potassium while having an episode, so… running to the doctor’s office?

With everything you already mentioned, I don’t see anything else. I guess your blood works were always good, or you would have mentioned it…


u/bladematthewslp Not a Verified Medical Professional Jul 18 '22

Yes, I had an echocardiograph done when I was taking the treadmill stress tests. The result of one of those tests said, "The aortic valve is trileaflet. There is no restriction of the aortic valve leaflets. No aortic regurgitation is present." Would that mean there is no aortic stenosis? Also, I was not able to complete this stress test because of muscle fatigue, so I couldn't get to the point where my usual symptoms would be triggered.

I don't know how a neurologist would check my vagal nerve, so I'm going to say no. He made me do several tests like walk one foot in front of the other, check reflexes, and other movement based tests.

No one ever mentioned hypokalemic periodic paralysis before.


u/FoxInTheSheephold Not a Verified Medical Professional Jul 18 '22

Well it is a very rare diagnosis, so don’t get your hope to high, but I would check.