episodic tachycardia in the setting of pac and pvc (premature atrial and ventricular contractions) is suggestive of arrhythmia may be atrial fibrillation or flutter. we should try to find the cause for it. do you smoke or have alcohol or any other stimulant drugs? do you suffer from snoring interrupted and unrefreshed sleep daytime sleepiness headaches etc? is there any history of exertional chest pain? since your holter has not picked anything the next step is the stress test. there is no harm in undergoing it and it will help us to rule out ischemic heart disease as well. do you have had any episodes when you were on holter? if not and you are having those episodes more frequently now then you can consider wearing holter again. otherwise undergo the stress test. the next option is electrophysiological studies and it is an invasive test but will diagnose and treat the arrhythmia in the same setting. i guess echo must be normal before starting flecainide. regarding treatment i would suggest beta blockers like metoprolol 25 mg to 50 mg according to heart rate and flecainide should be pill in pocket approach that is as and when needed. for further information consult a cardiologist online --> <link>
shall i get chemical stress test to know the reason for tachycardia?