Autonomic Nervous System Disorders and Heart Rate Issues

Autonomic nervous system disorder with tachycardia?

Hello, Doctor He.
I would like to ask you about my previous experience where I suddenly had symptoms of a heart attack while at rest (my left arm went completely numb up to my neck, my heart was racing, I had difficulty breathing, and felt faint).
Since then, I have continuously felt discomfort in my heart, experiencing severe chest pain, difficulty breathing, dizziness, and a feeling of pressure in my head.
Eventually, I started to have pain in all my joints and intense pain in my gums.
My heart rate has consistently felt elevated.
I understand that I have autonomic nervous system dysregulation, but despite trying various medications, both Western and traditional Chinese medicine, for six months, there has been no improvement.
However, since starting SNRIs at the beginning of this month, my heart condition has improved; I no longer feel like I'm on the verge of a heart attack, and my breathing has become easier.
The joint and gum pain has also decreased, but my heart rate remains high—measuring 110-120 bpm while sitting, 120-135 bpm when standing, and over 140-160 bpm during brisk walking or aerobic exercise.
Will the tachycardia caused by autonomic nervous system dysregulation improve? I am currently taking a beta-blocker, but the side effect is significant hair loss, and I am becoming quite bald.
Additionally, my hair has become very thin.

So my second question is, will having a consistently elevated heart rate, as described above, lead to heart failure? Is it possible to stop taking the beta-blocker? Could these symptoms be indicative of POTS syndrome? However, my heart rate exceeds 110 bpm even while sitting, and it definitely goes over 120 bpm when standing.
Moreover, my heart rate does not increase by more than 30 beats between sitting and standing, as it is already elevated while sitting.
My blood pressure has consistently been low at 90/60.
Have you encountered patients who experience such persistent heart discomfort that is actually due to autonomic nervous system dysregulation rather than organic disease? I would appreciate your help in understanding this.
Thank you!

Xiao Miu, 30~39 year old female. Ask Date: 2016/12/24

Dr. He Dongjin reply Cardiology

Hello, have you had your thyroid checked? The symptoms are related to POTS syndrome, where the heart beats irregularly but does not lead to heart failure.
It is possible to avoid beta-blockers.
Clinically, there are many patients who feel discomfort in their hearts all the time, but it is actually due to autonomic dysfunction rather than organic disease.
Don't worry, you should continue using SNRIs.
Changhua Hospital cares about you.

Reply Date: 2016/12/24

More Info

Understanding autonomic nervous system (ANS) disorders and their relationship with heart rate issues is crucial for managing symptoms and improving quality of life. The autonomic nervous system regulates involuntary bodily functions, including heart rate, blood pressure, and digestion. When this system is disrupted, it can lead to a variety of symptoms, including those you are experiencing.

From your description, it seems you have been dealing with significant anxiety and physical symptoms that may be linked to autonomic dysfunction. The sensations of rapid heart rate, chest pain, difficulty breathing, and feelings of faintness can be alarming and are often exacerbated by stress and anxiety. It is important to recognize that these symptoms can occur even in the absence of structural heart disease, particularly in cases of autonomic dysregulation.

Your experience with sudden episodes of rapid heart rate (tachycardia) and the feeling of impending doom can be indicative of panic attacks or anxiety-related disorders. The fact that you have been prescribed SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) suggests that your healthcare provider is addressing the anxiety component, which can significantly impact heart rate and overall well-being. It is encouraging to hear that you have noticed some improvement with this medication.

Regarding your heart rate readings, it is not uncommon for individuals with autonomic dysfunction to experience elevated heart rates, especially upon standing or during physical activity. This phenomenon can be related to a condition known as Postural Orthostatic Tachycardia Syndrome (POTS), which is characterized by an excessive increase in heart rate when transitioning from lying down to standing. However, your heart rate readings while sitting (110-120 bpm) are indeed elevated and warrant further evaluation.

As for your concerns about long-term heart function and the potential for heart failure, it is important to note that while persistent tachycardia can strain the heart, it does not automatically lead to heart failure in young individuals without underlying heart disease. Regular monitoring and management of your symptoms are key. The use of beta-blockers can help control heart rate and reduce anxiety symptoms, but if you are experiencing side effects such as hair loss, it is worth discussing alternative options with your healthcare provider.

In terms of your blood pressure readings (90/60), this may indicate low blood pressure, which can also be a symptom of autonomic dysfunction. It is essential to maintain adequate hydration and consider dietary adjustments to support blood pressure stability.

Lastly, it is not uncommon for patients with autonomic dysfunction to feel unwell without any identifiable organic disease. Many individuals experience debilitating symptoms due to the dysregulation of their autonomic nervous system, which can lead to a cycle of anxiety and physical discomfort. It is crucial to continue working with your healthcare team to find a comprehensive management plan that addresses both the physical and psychological aspects of your condition.

In summary, your symptoms may indeed be related to autonomic nervous system dysfunction rather than structural heart disease. Regular follow-up with your healthcare provider, lifestyle modifications, and adherence to prescribed medications can help manage your symptoms effectively. If you have ongoing concerns or if your symptoms worsen, seeking a referral to a specialist in autonomic disorders may provide additional insights and treatment options.

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