I have summitted three times. The first time (two years ago) I did not really spend much time acclimating. We spent the day at the portal the day before and slept in Lone Pine. I felt great at the summit. The next two times (last summer) I spent the two days prior to the hike at alititude, one night at Horseshoe and the next at the portal. Both times I felt horrible at the summit, I wanted to either throw up or take a nap. I was confused because I thought I did a much better job training and acclimating than I did the first trip. A month or so later I found out that I had a heart condition called Atrial Flutter and that my resting heart rate was around 120 and that there were signs that I had it for a while (looking back). My heart was re-booted and now I have a normal rhythm around 60. I am attempting to summit this Monday and I am hopeful that with a couple of days at altitude and a normal heartbeat I will feel like I did the first time.