When my symptoms were at their worst, yes, I felt my heart rate change with each cigarette. The obvious answer is to quit, and I did stop smoking for days at a time. I should have quit completely during that time, but I know this is weird, if I could smoke a cigarette and feel ok then it was reassuring to me that I was fine. So I kept trying a cigarette now and then just to see how it affected me. It's so backwards that it's embarassing to type that on the forum, but it's true. I tend to ignore my subtle symptoms until they get unbearable, and if smoking makes me feel a little off it's my little sign that I may be in for a rough day or two. I have always had low BP so I'm not sure about BP spikes, but I gave up caffeine during that time as well. And truth be told, even when I wasn't smoking for several days at a time, I still felt terrible, it just didn't directly follow a smoke.