Heart Rhythm Issues: Symptoms, Causes, and Solutions

Autonomic nervous system dysfunction? Arrhythmia? Heart failure? A mind full of questions?

Hello, Doctor.
When I was young, I occasionally experienced sharp, knife-like pain when inhaling, although it was infrequent.
Last year, I underwent a 24-hour Holter monitor and echocardiogram, during which my heart rate was around 50 beats per minute.
My normal heart rate is usually between 70 and 80 beats per minute.
The doctor mentioned that there is mild regurgitation in both valves.
I continued taking medication, but due to the severe pandemic situation, there was a period when I did not take my medication.
However, my condition improved slightly, although I still have trouble sleeping at night, waking up every 3 to 4 hours on average.
A few days ago, my heart rate suddenly remained above 85 beats per minute, and when I feel uncomfortable, it goes above 90 (even when sitting and resting).
The episodes occur approximately every 30 minutes to 1 hour, lasting about 10 to 30 minutes each time, accompanied by shortness of breath, chest tightness, dizziness, weakness in my limbs, decreased appetite, and difficulty concentrating.
I feel easily fatigued, somewhat like the sensation of being in a crowded place with low oxygen levels.
At night, I wake up gasping for air after about 1 to 1.5 hours of sleep and need to sit up to gradually feel better, but if I lie down too low, the symptoms return.
Last Friday, during a follow-up visit, the doctor prescribed Clonazepam 1.25 mg, to be taken in the morning, and ALPRAZOLAM 0.5 mg before bed to aid sleep.
However, after taking Clonazepam around 9:30 AM, it takes until about noon for me to feel relief from chest tightness and shortness of breath.
I am unsure if my condition is simply due to autonomic nervous system dysfunction.
There is a family history of heart disease (my mother’s side has a history of valve prolapse, etc.).
I still commute by bicycle every day and have a habit of brisk walking.
When I am not experiencing symptoms, I can move freely, but during episodes, even commuting and climbing stairs feels strenuous.
I would like to know the current stage of my physical condition and what methods might improve it.
Since appointments at large hospitals are often full, I feel a sense of urgency in asking these questions.
(If necessary, I can privately provide previous examination reports; please contact me via email.
Thank you.)

Ms. Wu, 20~29 year old female. Ask Date: 2020/06/22

Dr. He Dongjin reply Cardiology

Hello, mitral valve prolapse is not a major issue.
Symptoms like shortness of breath, chest tightness, dizziness, weakness in the limbs, decreased appetite, and difficulty concentrating suggest a state of autonomic nervous system imbalance rather than a straightforward heart condition, which typically presents with palpitations.
As long as there are no arrhythmias, it should be manageable.
It's important to adjust your medication, ensure you get good sleep, and take time to relax.
You can increase the dosage of KanKen tablets to 1.25 mg.
Once your symptoms stabilize, you can reduce the dosage back.
It seems to be simply an autonomic nervous system disorder.
Don't worry; Changhua Hospital cares about you.

Reply Date: 2020/06/22

More Info

Understanding heart rhythm issues can be complex, especially when symptoms like palpitations, chest discomfort, and fatigue are involved. Based on your description, it seems you are experiencing a range of symptoms that could be linked to various underlying causes, including anxiety, potential heart valve issues, and possibly autonomic nervous system dysregulation.

Symptoms and Their Possible Causes
1. Palpitations and Increased Heart Rate: You mentioned that your heart rate has been consistently above 85 beats per minute, even at rest. This can be attributed to several factors, including anxiety, stress, or even physical deconditioning. Given your history of panic attacks and anxiety, it’s plausible that these emotional states are contributing to your symptoms. Additionally, the presence of mild mitral and tricuspid regurgitation (leaky heart valves) could also lead to sensations of palpitations, especially during periods of stress or increased physical activity.

2. Chest Discomfort and Shortness of Breath: The feeling of chest tightness and shortness of breath can be alarming. While it’s important to rule out serious cardiac conditions, these symptoms can also be related to anxiety or panic attacks, particularly if they occur in conjunction with feelings of lightheadedness and fatigue. Your description of needing to sit up to alleviate breathlessness at night suggests that positional changes may be affecting your symptoms, which is common in individuals with anxiety or respiratory issues.

3. Fatigue and Sleep Disturbances: The fact that you are waking up frequently at night and feeling fatigued during the day can significantly impact your quality of life. Sleep disturbances are often linked to anxiety and can exacerbate feelings of fatigue and lack of concentration. The medications you are taking, such as Alprazolam, can help with sleep but may also lead to dependency if used long-term. It’s essential to discuss any ongoing sleep issues with your healthcare provider.

Recommendations for Improvement
1. Regular Monitoring: Since you have a history of heart valve issues and are experiencing new symptoms, it’s crucial to keep regular follow-ups with your cardiologist. If you feel that your symptoms are worsening or not improving with current medications, don’t hesitate to seek a second opinion or request further evaluations, such as a stress test or echocardiogram.

2. Lifestyle Modifications: Continue with your physical activities like cycling and brisk walking, as regular exercise can help improve cardiovascular health and reduce anxiety. However, listen to your body and avoid overexertion, especially during symptomatic episodes. Additionally, consider incorporating relaxation techniques such as deep breathing exercises, yoga, or mindfulness meditation to help manage anxiety.

3. Diet and Hydration: A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support overall health. Staying hydrated is also essential, as dehydration can lead to increased heart rates and fatigue.

4. Medication Review: Discuss with your doctor the effectiveness of your current medications. If you feel that they are not adequately controlling your symptoms, there may be alternative options available. It’s also important to address any concerns regarding potential side effects or dependency on medications like Alprazolam.

5. Mental Health Support: Given your history of panic attacks, consider seeking support from a mental health professional. Cognitive-behavioral therapy (CBT) has been shown to be effective in managing anxiety and can provide you with tools to cope with your symptoms.

Conclusion
Your symptoms warrant careful evaluation, especially given your family history of heart disease. While anxiety and stress may play a significant role in your current condition, it’s essential to rule out any underlying cardiac issues. Regular follow-ups with your healthcare provider, lifestyle modifications, and mental health support can significantly improve your quality of life. If you have any further questions or need clarification on your symptoms, don’t hesitate to reach out to your healthcare team.

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