Arrhythmia: Causes, Symptoms, and Treatment Options

Arrhythmia

Hello, doctor.
I experienced arrhythmia and chest tightness about a month and a half ago.
I feel chest tightness after meals, which is so severe that it feels like I can't breathe, along with palpitations.
Sometimes, I also experience palpitations when taking deep breaths or when changing positions while lying down at night.
I consulted a doctor who noted that I have significant heart murmurs.
I underwent an electrocardiogram (ECG) and an echocardiogram, which revealed mitral valve prolapse and insufficiency of both the tricuspid and mitral valves, with some mild regurgitation.
The ECG results were normal.
The doctor determined that my arrhythmia is caused by autonomic nervous system dysfunction and prescribed propranolol and vasodilators for control.
However, I still experience strong arrhythmia lasting about 5 to 6 seconds, occurring approximately 3 to 4 times a week.
I also feel palpitations with sudden changes in position, such as bending over, lying flat while sleeping, or during running.

I would like to ask the doctor:
1.
Can autonomic nervous system dysfunction cause arrhythmia due to changes in body position?
2.
Can benign arrhythmias be this intense? Is there a possibility that malignant arrhythmias were not detected during the 24-hour ECG monitoring?
3.
Should I take propranolol and vasodilators regularly even when I am not experiencing symptoms, or only during episodes?
Thank you for your answers, and I greatly appreciate your assistance!

Jack, 20~29 year old female. Ask Date: 2017/10/15

Dr. He Dongjin reply Cardiology

Hello Jack, autonomic nervous system dysregulation can lead to arrhythmias due to any changes, including postural changes, which can cause palpitations characterized by strong irregular heartbeats.
While there is a possibility of malignant arrhythmias that may not be captured by a 24-hour Holter monitor, the likelihood is very low.
Propranolol and similar vasodilators can be taken during episodes or increased in dosage during an episode.
Frankly, the situation does not appear to be serious, so there is no need for concern.
Changhua Hospital cares about you.

Reply Date: 2017/10/15

More Info

Understanding arrhythmia is crucial for managing symptoms and improving quality of life. Based on your description, it appears that you are experiencing a combination of symptoms related to arrhythmia, including chest discomfort, palpitations, and the sensation of your heart racing or skipping beats. These symptoms can be distressing and may significantly impact your daily activities.

Causes of Arrhythmia
Arrhythmias can arise from various factors, including structural heart issues, electrolyte imbalances, hormonal changes, and autonomic nervous system dysfunction. In your case, the presence of mitral valve prolapse and mild regurgitation suggests that there may be structural changes in the heart contributing to your symptoms. Additionally, your doctor has indicated that autonomic nervous system dysregulation may be a factor, which can lead to fluctuations in heart rate and rhythm, particularly during changes in body position or after meals.

Symptoms
The symptoms you describe—such as chest tightness, palpitations, and discomfort during certain activities or postures—are common in individuals with arrhythmias. The sensation of your heart racing or feeling irregular can be alarming, especially when it occurs frequently. It's important to note that while these symptoms can be associated with benign arrhythmias, they can also indicate more serious conditions that require further evaluation.

Treatment Options
1. Medications: Your doctor has prescribed propranolol, a beta-blocker, which is commonly used to manage symptoms of arrhythmia and anxiety. This medication can help stabilize heart rate and reduce palpitations. It's essential to follow your doctor's instructions regarding when to take this medication—whether to use it regularly or only during episodes of increased symptoms. If you are experiencing frequent episodes, your doctor may recommend a consistent dosing schedule.

2. Lifestyle Modifications: Certain lifestyle changes can help manage symptoms. These include:
- Avoiding Stimulants: Caffeine, nicotine, and certain medications can exacerbate arrhythmias.

- Stress Management: Techniques such as yoga, meditation, and deep-breathing exercises can help regulate the autonomic nervous system.

- Regular Exercise: Engaging in moderate physical activity can improve cardiovascular health and help regulate heart rhythms.

3. Monitoring: Continuous monitoring of your heart rhythm through a Holter monitor or event recorder may be beneficial, especially if your symptoms persist. This can help capture any irregularities that may not have been evident during a standard ECG.

Questions Addressed
1. Does autonomic nervous system dysregulation cause arrhythmias with position changes?
Yes, changes in body position can influence autonomic tone, leading to variations in heart rate and rhythm. This is particularly true for individuals with underlying autonomic dysfunction.

2. Can benign arrhythmias be intense?
While benign arrhythmias can cause noticeable symptoms, they typically do not present with severe or life-threatening manifestations. However, it is essential to differentiate between benign and potentially malignant arrhythmias, especially if symptoms are frequent or severe. If you have concerns about the possibility of a more serious arrhythmia, further evaluation may be warranted.

3. Should you take medications regularly or only during episodes?
This decision should be made in consultation with your healthcare provider. If your symptoms are frequent and disruptive, a regular dosing schedule may be appropriate. If they are infrequent, your doctor may recommend taking the medication only during episodes.

Conclusion
It is vital to maintain open communication with your healthcare provider regarding your symptoms and treatment plan. If your symptoms worsen or if you have new concerns, do not hesitate to seek further evaluation. Regular follow-ups can help ensure that your condition is managed effectively and that any necessary adjustments to your treatment plan are made in a timely manner. Your health and well-being are paramount, and proactive management of your symptoms can lead to improved quality of life.

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