Managing Heart Palpitations: Insights on Anxiety and Autonomic Dysfunction

Request for Consultation: Examination Report

Director He Ping'an previously asked you some questions and recently saw you sharing knowledge on a program, along with the biblical proverb "A joyful heart is good medicine." I would like to ask you a few questions, and I apologize for the length.
Thank you.

About six months ago, after consuming mixed alcohol, I experienced rapid heartbeat issues.
Initially, I went to a private hospital in Taipei for examination, where a young doctor reported that he found nothing significant but insisted on hospitalization, stating "suspected" additional nerve involvement and recommended a cardiac catheterization.
I was quite anxious about this, so I copied the entire report and sought a consultation with a well-respected cardiologist at the Veterans General Hospital.
This kind and experienced doctor reviewed the report and listened to my heart for about five minutes.
He remarked that the previous doctor was too hasty and that my condition was not that serious.
He then smiled and mentioned that I had bilateral mitral valve prolapse (which the previous doctor had not mentioned), suggesting that this might have triggered autonomic nervous system dysregulation.
He explained that an electrophysiological study could be done, which could be covered by health insurance, and that it was an invasive procedure that would cause some discomfort for the patient.
Afterward, I researched the report and confirmed that there were indeed episodes of heart rates exceeding 150 beats per minute occurring once every 24 hours, but there were no indications of serious arrhythmias such as VT, PSVT, or AF.
My normal heart rate was 99.XX%, and the arrhythmia percentage was 0.XX%, with an average heart rate around 80.
Later, I consulted a psychosomatic specialist who found that my sympathetic nervous system was slightly overactive while my parasympathetic nervous system was somewhat weak, indicating that my autonomic nervous system was not within normal limits.
The psychosomatic specialist believed that the dysregulation of the autonomic nervous system had triggered panic disorder.
I have been on medication for some time now, and my condition has stabilized.
Initially, I experienced episodes of rapid heartbeat about once every two weeks, but now it has reduced to once every two months, with the duration of episodes decreasing from 1-2 minutes to just a few seconds.
My peak heart rate has also dropped to around 100-110 beats per minute.

I find that I am particularly sensitive to my heart rate when climbing stairs, and I often worry that my heart rate will increase, which seems to trigger anxiety and makes my heart race even more.
Although I have faith and pray, I remain concerned about what the previous doctor said, which has caused me some fear in my daily life and has made it difficult for me to return to normalcy in my work.
Therefore, I would like to ask Director He:
1.
Can I stop worrying about what that doctor said and return to a normal life and work?
2.
Regarding my fear of increased heart rate when climbing stairs, I sometimes feel that my heart is racing after climbing, but resting stabilizes it.
I have no other symptoms, just the sensation of my heartbeat.
Both traditional and Western medicine have advised me to adapt and not to be overly anxious, suggesting that once my autonomic nervous system stabilizes, these issues will resolve.
Is it true that I can simply coexist peacefully with this condition?
Thank you for your advice and encouragement.
Peace and joy.

conley, 20~29 year old female. Ask Date: 2019/07/11

Dr. He Dongjin reply Cardiology

Hello, you really don't need to worry about what that doctor said regarding the extra nerve; it does not pose any life-threatening risk.
Don't stress, just live your life normally and enjoy it.
It's natural to feel anxious, but as your autonomic nervous system stabilizes, things will gradually improve.
Allow your heart to take a break and stabilize; just give it some space to bounce a little.
It won't harm your body, so there's no need to worry.
Just coexist peacefully, and may God bless you.
Changhua Hospital cares about you.

Reply Date: 2019/07/11

More Info

Managing heart palpitations, especially in the context of anxiety and autonomic dysfunction, can be a complex issue that requires a multifaceted approach. Your experience highlights the interplay between physical symptoms and psychological factors, which is common in individuals dealing with anxiety disorders and autonomic nervous system imbalances.

Firstly, it's important to understand that heart palpitations can be triggered by a variety of factors, including anxiety, stress, and changes in physical activity. In your case, the history of consuming alcohol and the subsequent rapid heartbeat may have been exacerbated by anxiety and autonomic dysfunction. The autonomic nervous system, which regulates involuntary bodily functions, can become dysregulated due to stress and anxiety, leading to symptoms like palpitations.

Your experience with multiple doctors and varying opinions is not uncommon in the medical field, especially when it comes to conditions that have both physical and psychological components. The fact that a more experienced physician reassured you about the severity of your condition is a positive sign. It indicates that while you may have some benign heart valve issues (like mitral valve prolapse), these are often not serious and can be managed effectively.

Regarding your specific questions:
1. Returning to Normal Life: Yes, it is entirely possible to return to your normal life and work. It’s crucial to focus on what you can control, such as managing your anxiety and maintaining a healthy lifestyle. Engaging in regular physical activity, as you have started with jogging, can significantly help in reducing anxiety and improving your overall cardiovascular health. The key is to gradually increase your activity level and listen to your body. If you feel your heart rate increase, remind yourself that this is a normal physiological response to exercise.

2. Fear of Heart Rate Increases: It’s understandable to be sensitive to changes in your heart rate, especially after experiencing palpitations. However, it’s essential to recognize that physical activities like climbing stairs will naturally elevate your heart rate. The more you focus on your heart rate, the more anxious you may become, which can create a cycle of fear and increased heart rate. Practicing mindfulness and relaxation techniques can help you manage this anxiety. Techniques such as deep breathing, meditation, or yoga can be beneficial in calming your mind and body.

Your doctors' advice to adapt and not overthink your symptoms is sound. It’s essential to cultivate a mindset of acceptance towards your body’s responses. Over time, as your autonomic nervous system stabilizes and your anxiety decreases, you may find that your sensitivity to heart rate changes diminishes as well.

In addition, consider discussing with your healthcare provider about cognitive behavioral therapy (CBT) or other therapeutic approaches that can help you address the anxiety component of your symptoms. CBT is particularly effective for anxiety disorders and can provide you with tools to manage your thoughts and reactions to physical sensations.

Lastly, maintaining regular follow-ups with both your cardiologist and mental health professional is crucial. They can monitor your progress and make adjustments to your treatment plan as necessary. Remember, it’s a journey, and with time and the right support, you can regain control over your life and health.

In summary, focus on managing your anxiety, engage in regular physical activity, and practice mindfulness. With time and consistent effort, you can navigate through these challenges and return to a fulfilling life.

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