Arrhythmia and Autonomic Nervous System Disorders

Arrhythmia and autonomic nervous system dysfunction?

Hello, doctor.
I am currently studying in Hsinchu.
I first experienced arrhythmia at the end of 2016, when I was taken to Mackay Memorial Hospital's emergency room, where my heart rate was about 200 beats per minute.
However, after observation in the hospital, it returned to normal.
Later, I went to National Taiwan University for an exercise electrocardiogram, echocardiogram, and chest X-ray, and I also underwent a 24-hour Holter monitor test, all of which showed no issues.
The only thing noted was that there was a larger potential difference in a certain part of my electrocardiogram (I am not very clear about this, but the doctor said it was normal).
Therefore, the doctor suspected it was autonomic nervous system dysregulation and prescribed me Inderal, advising me to take it during episodes.
Over the past few years, I have experienced episodes about once or twice a year, usually waking up suddenly in the early morning, feeling my heart racing, but not as severely as the first time.
After taking the medication, it is quickly controlled.
I have also gone for check-ups after these episodes, but no issues were found, except that my cholesterol and triglycerides are slightly elevated (possibly due to family history; I am 175 cm tall and weigh 68 kg).

Recently, I have been feeling unusual sensations in my left chest every day (not feeling my heartbeat), and I am uncertain if it is chest tightness.
This sensation may occur two to three times a day, lasting one to two hours, or disappearing within half an hour.
When I experience this, I measure my blood pressure and heart rate, both of which are normal.
The symptoms are tolerable.
I would like to ask if this condition can also be considered arrhythmia and if it could be caused by autonomic nervous system dysregulation.
I usually exercise, jog, and play the piano to relieve stress, and I have also learned abdominal breathing techniques, but I still have these symptoms.
Do you have any suggestions to help improve this issue, or should I just continue to observe?

Kevin, 20~29 year old female. Ask Date: 2019/10/06

Dr. He Dongjin reply Cardiology

Hello, if you feel that your blood pressure and heart rate are normal, it does not count as arrhythmia.
It may be caused by autonomic nervous system dysfunction, leading to elevated cholesterol and triglycerides, which do not affect the improvement of this issue.
Engaging in fitness, jogging, and playing the piano are all beneficial.
Even the most outstanding students do not score 100 on every exam; occasional issues are normal and reasonable, so it's best to coexist peacefully with them.
In case of a major episode, you can take Inderal again.
Changhua Hospital cares about you.

Reply Date: 2019/10/06

More Info

Hello! Thank you for sharing your experience regarding arrhythmia and the potential connection to autonomic nervous system (ANS) disorders. It sounds like you've been through quite a journey since your first episode of rapid heart rate in 2016. Let's break down your situation and explore the relationship between arrhythmia and autonomic nervous system disorders, as well as some potential strategies for managing your symptoms.

Understanding Arrhythmia
Arrhythmia refers to an irregular heartbeat, which can manifest as a heart that beats too fast (tachycardia), too slow (bradycardia), or in an irregular pattern. Your experience of a heart rate of around 200 beats per minute is indicative of tachycardia, which can be alarming. However, it's reassuring that subsequent tests, including exercise electrocardiograms and 24-hour Holter monitoring, have not revealed any underlying structural heart issues. The fact that your heart rate normalizes after episodes is also a positive sign.

Autonomic Nervous System and Arrhythmia
The autonomic nervous system plays a crucial role in regulating heart rate and rhythm. It consists of two main branches: the sympathetic nervous system, which prepares the body for 'fight or flight' responses (increasing heart rate), and the parasympathetic nervous system, which promotes 'rest and digest' functions (slowing heart rate). Dysregulation of this system can lead to symptoms like those you've described, including palpitations and a sensation of chest discomfort.

Your physician's suspicion of autonomic nervous system dysfunction is valid, especially given that stress and anxiety can exacerbate these symptoms. The fact that you experience episodes primarily at night may suggest a link to your body's natural circadian rhythms and how they interact with stress and relaxation.

Chest Discomfort and Anxiety
The left chest discomfort you're experiencing, which is not directly related to your heartbeat, could be a manifestation of anxiety or stress. It's common for individuals with a history of arrhythmia to develop heightened awareness of bodily sensations, leading to increased anxiety about potential heart issues. Since you've mentioned that your blood pressure and heart rate are normal during these episodes, it may be less likely that they are directly related to arrhythmia.

Management Strategies
1. Medication: It seems that Inderal (propranolol) has been effective in managing your symptoms during episodes. Continue to follow your doctor's advice regarding medication usage, especially during acute episodes.

2. Lifestyle Modifications: Maintaining a healthy lifestyle is crucial. Regular exercise, such as running and strength training, can help improve cardiovascular health and reduce stress. Additionally, practicing abdominal breathing techniques can enhance relaxation and may help mitigate anxiety-related symptoms.

3. Stress Management: Since you mentioned using music (playing the piano) as a stress relief method, consider incorporating more activities that promote relaxation, such as yoga, meditation, or mindfulness practices. These can help regulate the autonomic nervous system and reduce the frequency of episodes.

4. Monitoring: Keep a diary of your symptoms, noting when they occur, their duration, and any potential triggers (like stress or dietary factors). This information can be valuable for your healthcare provider in assessing your condition.

5. Regular Check-ups: Continue to have regular follow-ups with your healthcare provider to monitor your cholesterol and triglyceride levels, as well as your overall cardiovascular health. If your symptoms persist or worsen, further evaluation may be warranted.

Conclusion
In summary, while your symptoms may be related to arrhythmia, they could also stem from autonomic nervous system dysregulation, particularly in the context of stress and anxiety. It's essential to maintain open communication with your healthcare provider and to explore both medical and lifestyle approaches to manage your symptoms effectively. Remember, self-care and stress management are key components in navigating your health journey. If you have any further questions or concerns, don't hesitate to reach out to your healthcare team. Wishing you all the best in your studies and health!

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