Palpitations: The Role of Autonomic Nervous System Dysfunction

Q: Palpitations: The Role of Autonomic Nervous System Dysfunction

Hello： Generally speaking, the autonomic nervous system is regulated by the sympathetic and parasympathetic nervous systems, where one acts as the accelerator and the other as the brake. <br>The sympathetic nervous system is responsible for accelerating the body, driving it into

Palpitations caused by autonomic nervous system dysfunction?

Hello Doctor, I hope you are well.
I remember that at the end of last year, my sleep schedule was irregular due to alcohol consumption.
One night, I woke up in a panic with palpitations, feeling anxious and fearful, my hands were shaking, and my chest felt numb.
I thought I was about to die, so I immediately ran downstairs and called 911, but I felt better shortly after.
When I went to the hospital, the doctor suggested it might be panic disorder or a thyroid issue.
Later, I went to Taipei Veterans General Hospital for a series of cardiac tests.
Fortunately, the 24-hour Holter monitor captured an episode when I experienced palpitations and panic after walking nearly a kilometer, with my heart rate accelerating quite rapidly.
However, the doctor concluded that there was no significant arrhythmia, although I was diagnosed with mitral valve prolapse.
I believe my symptoms are related to the mitral valve and autonomic nervous system.

Since then, I have experienced numerous symptoms daily, including sudden episodes of increased heart rate, strong heartbeats, and awareness of my heartbeat, with rates between 110-130 bpm lasting from a few seconds to two minutes.
There have been days of persistent tinnitus, occasional abdominal bloating, panic, an aversion to being alone, and an inability to handle stress (which causes noticeable increases in heart rate and intensity).
I often feel like I am not getting enough air, with a sensation of something stuck in my throat to my chest, which is very uncomfortable.
At night, it feels like my whole body is shaking as if in an earthquake, accompanied by a sense of fear.
Sometimes, when I get up or move from a relatively static position to dynamic activity, I experience discomfort as if adrenaline is being secreted to my heart, causing it to speed up, which can even lead to a sensation of my heart racing.
This has made me feel worse than death.

I underwent HRV (Heart Rate Variability) testing in the psychosomatic department, and the doctor said the normal range is 0.8-1.5, but mine was 1.9, with sympathetic dominance at 65% and parasympathetic at 35%, indicating an imbalance.
I would like to ask the doctor if this is related to the autonomic nervous system.
Thank you.

Niming, 20~29 year old female. Ask Date: 2019/08/27

Dr. Jiang Junyi reply Neurology

Hello: Generally speaking, the autonomic nervous system is regulated by the sympathetic and parasympathetic nervous systems, where one acts as the accelerator and the other as the brake.
The sympathetic nervous system is responsible for accelerating the body, driving it into action, while the parasympathetic nervous system is responsible for slowing it down, allowing the body to rest.
For example, during exercise, the sympathetic nervous system is activated, leading to increased heart rate, faster breathing, and increased sweating.
Once the exercise stops, the parasympathetic nervous system begins to take effect, slowing the heart rate, reducing breathing rate, and decreasing sweating.
Your symptoms seem to resemble excessive activation of the sympathetic nervous system.
You might want to try enhancing parasympathetic function through activities such as one-minute deep breathing, stretching, or brisk walking.
Additionally, I wonder if you might be overweight? Sometimes, sleep apnea can also cause similar symptoms.
I recommend discussing this with a neurologist for further evaluation.
Wishing you good health and peace.
Dr.
Jiang from the Department of Neurology at Taoyuan Hospital cares about you.

Reply Date: 2019/08/27

More Info

Palpitations can be a distressing experience, often accompanied by feelings of anxiety and fear. Your symptoms, including rapid heart rate, feelings of panic, and physical sensations such as trembling and chest discomfort, suggest a potential dysfunction of the autonomic nervous system (ANS). The ANS regulates involuntary bodily functions, including heart rate, digestion, and respiratory rate, and is divided into two main branches: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS).

In your case, the symptoms you described, such as heart palpitations, increased heart rate (tachycardia), and feelings of panic, may be linked to an overactive sympathetic nervous system. The SNS is responsible for the "fight or flight" response, which prepares the body to respond to perceived threats. When activated, it can lead to increased heart rate, elevated blood pressure, and heightened alertness. This response can be triggered by stress, anxiety, or even physical exertion, as you experienced after walking a significant distance.

Your heart rate variability (HRV) results indicate a predominance of the sympathetic nervous system (65%) over the parasympathetic system (35%). A higher sympathetic tone can lead to symptoms such as palpitations and anxiety, as the body remains in a heightened state of arousal. This imbalance may also explain why you feel discomfort during transitions from rest to activity, as your body may struggle to appropriately regulate heart rate and blood pressure in response to changes in activity levels.

The connection between autonomic dysfunction and palpitations is well-documented. Conditions such as panic disorder, anxiety disorders, and even certain physical health issues (like mitral valve prolapse, which you mentioned) can contribute to this dysfunction. The interplay between psychological factors (like anxiety) and physiological responses (like heart rate changes) can create a cycle that exacerbates symptoms. For instance, the fear of experiencing palpitations can lead to increased anxiety, which in turn can trigger more palpitations, creating a feedback loop.

To address these symptoms, it is essential to consider both medical and psychological approaches. Here are some strategies that may help:
1. Cognitive Behavioral Therapy (CBT): This form of therapy can be effective in managing anxiety and panic symptoms. It helps individuals identify and change negative thought patterns and behaviors that contribute to anxiety.

2. Relaxation Techniques: Practices such as deep breathing exercises, progressive muscle relaxation, and mindfulness meditation can help activate the parasympathetic nervous system, promoting relaxation and reducing anxiety.

3. Lifestyle Modifications: Regular physical activity, a balanced diet, and adequate sleep can improve overall autonomic function. Avoiding stimulants like caffeine and nicotine may also help reduce palpitations.

4. Medication: If symptoms persist, discussing medication options with your healthcare provider may be beneficial. Beta-blockers, for instance, can help manage heart rate and reduce anxiety symptoms.

5. Monitoring and Follow-Up: Regular follow-up with your healthcare provider to monitor your symptoms and adjust your treatment plan as necessary is crucial. If your symptoms worsen or new symptoms arise, further evaluation may be needed.

In summary, your experience of palpitations and associated symptoms appears to be linked to autonomic nervous system dysfunction, likely exacerbated by anxiety and stress. By addressing both the physiological and psychological aspects of your condition, you can work towards alleviating your symptoms and improving your overall quality of life. Always consult with your healthcare provider for personalized advice and treatment options.

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