the Connection Between Palpitations and Autonomic Nervous System

The relationship between palpitations and the autonomic nervous system?

Hello, Doctor.
I have two questions I would like to ask, but let me first describe my medical history, which is not heart-related, for your review.
During my university entrance exams, I experienced extreme stress and anxiety, leading to hyperventilation.
After completing the exams and officially becoming a university student, I overindulged in alcohol at a welcome party, which resulted in a series of gastrointestinal discomforts, including heartburn, bloating, nausea, acid reflux, and stomach cramps.
I initially suspected inflammation or a gastric ulcer, so I underwent an endoscopy, but the doctor found nothing wrong.
I was surprised that my stomach discomfort persisted despite three months of Western medication without improvement.
After 2-3 years of ongoing issues, I adjusted my mindset and started taking traditional Chinese medicine, which helped me recover.
It wasn't until I experienced another episode, this time related to my heart, that I truly understood the condition known as "autonomic nervous system dysfunction."
I graduated and started working at a foreign company, which is highly regarded, but my health deteriorated due to excessive drinking during social events, and my symptoms shifted to your area of expertise—my heart.
I experienced all the typical heart symptoms: panic, rapid heartbeat, palpitations, feelings of anxiety, skipped beats, and shortness of breath.
I collectively referred to these symptoms as "palpitations." Of course, there were also non-cardiac symptoms, but I won't elaborate on those since they are outside your specialty.
Initially, I genuinely thought I had heart disease, but there is no family history of such conditions, and I play on a sports team, so how could I suddenly develop heart disease? I researched extensively online and frightened myself with various possible conditions, suspecting I had tachycardia and heart failure due to my symptoms.
Ultimately, I went to a major hospital for a check-up.
Most tests came back normal, but I was diagnosed with mitral valve prolapse (which explained why I often felt short of breath during intense exercise, thinking it was due to low lung capacity).
The 24-hour Holter monitor showed that during my panic episodes, my heart rate increased and became forceful.
The doctor reviewed the report and ruled out any malignant arrhythmias.
Although the doctor did not mention autonomic nervous system issues, it was noted in the educational materials, which made me realize that "autonomic nervous system dysfunction" had returned.
Now, I have been on medication for almost a year.
I no longer take the anti-anxiety medication for panic attacks, and I have reduced the beta-blocker to half a tablet in the morning and evening.
My condition has been improving.
Each time I return for a follow-up, the doctor advises me to continue the medication until I accept that my heart is functioning as it is, at which point I can stop.
However, I still have the two questions I mentioned earlier:
Question 1: Sometimes (mostly after meals), I inexplicably feel my heart rate slightly increase, accompanied by some anxiety and a more pronounced heartbeat.
During these times, I prefer not to engage in any activity for fear of worsening the situation, so I rest and practice deep breathing, and after about thirty minutes, it usually resolves.
Additionally, sometimes when I am about to fall asleep at night, I wake up suddenly feeling a bit panicked, with a slightly increased heart rate and a sensation of my body shaking.
However, if I quickly shift my focus and practice controlled breathing, I can return to normal.
I would like to ask if this is related to the autonomic nervous system still not being fully balanced, leading to these cardiac symptoms?
Question 2: Due to my previous panic attacks, I have become very sensitive to my heartbeat.
For instance, after running a short distance and then stopping, I often feel my heart racing for a few seconds, and I may experience a bit of breathlessness or a strong heartbeat when I am nervous.
Is this a normal phenomenon? I seem to associate these sensations with my previous panic episodes, which makes me more anxious and causes my heart to race closer to the edge of another episode.
Am I overthinking this? Can I gradually accept that I can still engage in normal activities like exercising, running, or watching thrilling movies?
Thank you very much for taking the time to read my "essay." I appreciate your effort, especially with the recent pandemic issues.
I hope everyone stays safe as we move past this situation.

Hitori, 20~29 year old female. Ask Date: 2020/02/24

Dr. He Dongjin reply Cardiology

Hello, regarding your first question, it is indeed related to the autonomic nervous system not being fully balanced, which can lead to cardiac symptoms.
You are overly sensitive to your heartbeat.
It's completely normal for your heart rate to increase and feel stronger when you run or feel anxious.
If your heart rate didn't increase, how would your body meet its demands? Accept the way your heart beats; you may experience palpitations, but as long as there are no serious arrhythmias, there's no need to worry.
You can exercise, run, jump, and watch thrilling movies just like anyone else.
Don't worry, Changhua Hospital cares about you.

Reply Date: 2020/02/24

More Info

Hello! Thank you for sharing your detailed medical history and concerns. It sounds like you've been through quite a journey with your health, particularly regarding your experiences with anxiety, gastrointestinal issues, and now heart-related symptoms. Let's address your questions about the connection between palpitations and the autonomic nervous system (ANS).

Understanding the Autonomic Nervous System
The autonomic nervous system is a crucial part of our nervous system that regulates involuntary bodily functions, including heart rate, digestion, respiratory rate, and more. It has two main branches: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). The SNS is responsible for the "fight or flight" response, which can increase heart rate and blood pressure during stressful situations. In contrast, the PNS promotes the "rest and digest" state, helping to calm the body down.

Question 1: Heart Rate Changes After Eating and Nighttime Panic
Your experience of feeling your heart rate increase after meals and during nighttime awakenings can indeed be related to the autonomic nervous system. After eating, the body directs more blood flow to the digestive system, which can sometimes lead to a temporary increase in heart rate. This is a normal physiological response, but if you're already predisposed to anxiety or have a heightened sensitivity to bodily sensations, it can feel more pronounced and lead to feelings of panic.

The nighttime panic you described, where you wake up feeling anxious and with a racing heart, is also common among individuals with anxiety disorders. This can be linked to the body's natural circadian rhythms and the way the autonomic nervous system regulates heart rate during different sleep stages. When you transition from wakefulness to sleep, your body undergoes various changes, and if you're already anxious, these changes can trigger feelings of panic.

Question 2: Sensitivity to Heart Rate Changes During Activity
Feeling your heart rate increase after physical activity or during moments of stress is also a normal response. When you exercise, your heart rate naturally increases to supply more oxygen to your muscles. However, if you have a history of panic attacks or anxiety, you may become hyper-aware of these sensations, leading to a cycle of anxiety where you fear that your heart is racing too much or that something is wrong.

It's essential to recognize that while these sensations can be uncomfortable, they are often benign, especially since your medical evaluations have ruled out serious heart conditions. The key is to work on desensitizing yourself to these sensations. Techniques such as mindfulness, deep breathing, and gradual exposure to physical activity can help you become more comfortable with your body's responses.

Moving Forward
It's great to hear that you're seeing improvement with your current medication regimen. Continuing to follow your doctor's advice and gradually reducing medication under supervision is a wise approach. Additionally, consider incorporating stress-reduction techniques into your routine, such as yoga, meditation, or regular physical activity, which can help balance your autonomic nervous system and reduce anxiety.

Lastly, it's crucial to maintain open communication with your healthcare provider about your symptoms and any changes you experience. They can provide tailored advice and adjustments to your treatment plan as needed.

In summary, your experiences with palpitations and anxiety are closely linked to the autonomic nervous system's functioning. Understanding this connection can empower you to manage your symptoms better and improve your overall well-being. Remember, it's okay to seek support from mental health professionals as you navigate these challenges. Take care, and I wish you continued progress on your health journey!

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