Heart rate goes up absurdly high in the morning, answers needed

Hi everyone,

To start with demographics, I'm a 22 y.o. female with a high-stress lifestyle (breadwinner of family, academic high-achiever, slew of trauma/emotional health issues). I was in the hospital for a month because of random bursts of sinus tachycardia, especially in the morning. It's like I would wake up and suddenly the heart monitor in the hallway would alarm and a nurse would come into my room being like, "are you okay?". I would feel strange -- I wouldn't feel my heart "palpitate" (except when it gets to like 160-180, or if I stand up), but I would feel really warm and generally uncomfortable (as if I had a high fever, like I had with covid -- when I went to the ER for a 104 degree fever, my HR was around 146 and I had that same exact feeling).

So in the morning, whenever I roll over, stretch, or change position without my beta blocker, my heart rate would usually climb by the 30s-50s. I remember doing this when I was discharged and one *lovely day* my heart rate soared up to 183 from 74, which prompted a visit from the paramedics and another 14-day hospital stay. I also have POTS, and my hospital journey began when I stood up and immediately passed out with a heart rate of 160 after getting out of bed in the morning.

I've associated this with "adrenaline surges" (which POTS patients sometimes get(?) but I'm not sure). I have hormonal issues (was diagnosed with hyperandrogenism) -- which was pretty obvious to anyone, not even just doctors (acne, messed up periods, etc.). But the doctors were telling me that this hyperandrogenism and POTS/weird bursts of tach were unrelated (sure, lol). It's weird because I would just be calm, laying down, not really doing much, and my heart rate would flip out.

Medications: 200 mg acebutolol 1x a day (since then I've not been having much of these adrenaline surges -- though I did on metoprolol --but the absurd increase in heart rate still happens in the morning), 10 mg midodrine 3x a day, Ativan 1x a day (because they injected me with that stuff every day while in the hospital to stop "seizure-like episodes" and I developed physical dependence on it -- trying to wean off though). I was never on any sort of medication before all of this happened.

Test results: low-normal potassium (which I've always had), low vitamin D (always had), elevated androgens (always had), everything else normal

Other info:

- Sometimes I wake up feeling out of breath (as if my body literally lacks oxygen). This has been happening for a few years. I wasn't tested for central sleep apnea but I assume this could have a stress component to it.
- I would feel out of breath around the start or the very end of my period.
- I would get short of breath while just talking to someone (maybe because I talk fast, which my partner has observed).
- As I've mentioned previously, I had covid. I'd say it was a moderate case but the fever caused me to go to the ER. There could be some inflammation/damage from that. Maybe this POTS thing is long covid, who knows.
- I initially went to the ER the day before this crap fest happened for shaking/tremors and they gave me a beta blocker (this was my first time on a beta blocker, propranolol, and after having it, my heart rate got worse). I'm starting to think a withdrawl loop is a possibility because I wasn't able to take the full dose of the beta blocker (some of it got in my system).
- Endocrinologist felt my thyroid and found it was enlarged.

My normal resting heart rate is in the 80s. After recovering from covid, it shifted to the 90s/100s. And last month I couldn't even walk or sit up without passing out with a HR of 150 or something (sometimes I would pass out just laying down) -- overall feeling awful. Answers much needed.

So I'm guessing there are multiple factors that are playing into this, but my guess is 50% physical and 50% mental (or maybe everything has a root in the overly stressed mind minus the covid). Please advise. I don't want to keep going back to the hospital.