If I'm under extreme stress, once that adrenalin kicks in, bang, tachycardia, lightheaded, numbness. The worst part is, I can't defend myself because I'm struggling just to breathe and not faint. Abnormal stress response. Then the next day, it's like my adrenals are stripped and I have the PEM, plus a fever. My other triggers are nitrates and garlic in the food. Not enough salt. And hot showers or showers that are too warm. Also weather changes.