Autonomic Nervous System Disorders and Heart Palpitations

Is it autonomic nervous system dysfunction?

Hello Doctor, I was born in Hong Kong and noticed that your website in Taiwan has a lot of information regarding this symptom, so I specifically came to consult you.
In the past few months, I have started experiencing palpitations.
In May, I was hospitalized for a cardiac evaluation, which included an echocardiogram, a CT scan, and two 24-hour Holter monitors, as well as X-rays.
The cardiologist stated that they found no issues; the heart's blood vessels and structure were all normal, and heart function was ideal.
The 24-hour Holter monitor only detected nine instances of premature atrial contractions (PACs), and the doctor mentioned that this is common and not a cause for concern.
The cardiologist prescribed some heart rate medications (Inderal, propranolol) and encouraged me to exercise more boldly.
However, I am somewhat afraid to exercise due to my fear of experiencing palpitations.
In summary, the cardiologist could not identify any other causes and seemed unaware of the term autonomic nervous system dysfunction.
Since the examination last month, I have experienced palpitations again, suddenly feeling uncomfortable with one or two heartbeats while at rest, along with a slight burning sensation in my face.
I find it hard to describe this discomfort, which significantly affects my mood and daily activities, especially in the morning upon waking and after meals when my heart rate accelerates rapidly.
Sometimes it feels very uncomfortable, and I experience palpitations.
Once, after drinking hot water in the morning, I felt discomfort in my heartbeat, even experiencing a couple of skipped beats, which makes me worry every morning about whether I will experience palpitations again that day.
Aside from the cardiologist, private general practitioners have also found no issues and suggested that it is due to anxiety.
In fact, I have had these symptoms for ten years, but they have recently become more severe.
Ten years ago, I underwent a standard ECG, and the doctor said my heartbeat was sinusoidal but very rapid, so I was referred to a psychiatrist.
I have been taking a serotonin medication (sertraline) since then, currently at two pills a day, but I still experience palpitations, which are quite recurrent.
Could you please advise if I might have autonomic nervous system dysfunction? If so, how should I manage and treat it? Should I request a change in my serotonin medication? I visited a traditional Chinese medicine practitioner yesterday, but I am unsure of its effectiveness.
I would greatly appreciate any valuable advice you could provide, as it seems that doctors in Hong Kong only say there is no heart problem but cannot find a reason for my symptoms.
Thank you.

Mr. Yu, 30~39 year old female. Ask Date: 2020/08/11

Dr. He Dongjin reply Cardiology

Hello, the feeling of missed beats and facial flushing can be managed by increasing the dosage of propranolol and sertraline to three times a day for now.
Once your condition stabilizes, you can reduce the dosage back down.
Don't worry, palpitations are not a disease and pose no life-threatening risk; sudden cardiac death is not a concern.
Symptoms of autonomic nervous system dysregulation can fluctuate, so adjust the medication dosage according to your symptoms.
Take care, and we at Changhua Hospital are here for you.

Reply Date: 2020/08/11

More Info

Hello! Thank you for reaching out with your concerns regarding heart palpitations and the potential link to autonomic nervous system (ANS) disorders. It sounds like you have been through a comprehensive evaluation, and I appreciate your detailed description of your symptoms and medical history.

From what you've shared, it seems that your heart has been thoroughly examined, and the results indicate that there are no structural issues or significant arrhythmias. The presence of premature atrial contractions (PACs) is indeed common and often benign, which aligns with what your cardiologist has advised. However, your ongoing symptoms of palpitations, especially in conjunction with anxiety and emotional distress, suggest that there may be a connection to autonomic nervous system dysregulation.

The autonomic nervous system controls involuntary bodily functions, including heart rate, digestion, and respiratory rate. It consists of two main branches: the sympathetic nervous system (which prepares the body for 'fight or flight' responses) and the parasympathetic nervous system (which promotes 'rest and digest' activities). An imbalance between these systems can lead to symptoms such as palpitations, anxiety, and other physical sensations that you are experiencing.

Your history of anxiety and the use of selective serotonin reuptake inhibitors (SSRIs) like sertraline indicate that you have been managing anxiety symptoms for some time. While SSRIs can be effective for anxiety and depression, they may not directly address the physical symptoms of autonomic dysregulation, such as palpitations. It’s important to communicate with your healthcare provider about your ongoing symptoms and discuss whether adjustments to your medication or additional treatments might be beneficial.

In terms of managing your symptoms, here are several strategies that may help:
1. Cognitive Behavioral Therapy (CBT): This form of therapy can be effective in addressing anxiety and the physical sensations associated with it. It helps you understand and change the thought patterns that contribute to your anxiety and palpitations.

2. Mindfulness and Relaxation Techniques: Practices such as deep breathing exercises, meditation, and yoga can help calm the nervous system and reduce anxiety. These techniques can also help you manage the physical sensations of palpitations when they occur.

3. Regular Physical Activity: Although you mentioned feeling hesitant to exercise due to your palpitations, engaging in regular, moderate exercise can actually help regulate your autonomic nervous system and improve your overall cardiovascular health. Start with low-impact activities, such as walking or swimming, and gradually increase your activity level as you feel more comfortable.

4. Diet and Hydration: Pay attention to your diet, as certain foods and beverages (like caffeine and alcohol) can exacerbate palpitations. Staying well-hydrated is also important for overall health.

5. Sleep Hygiene: Ensure you are getting adequate sleep, as poor sleep can worsen anxiety and autonomic dysregulation. Establish a calming bedtime routine and aim for consistent sleep patterns.

6. Follow-Up with Specialists: If your symptoms persist, consider seeking a referral to a specialist in autonomic disorders or a cardiologist with expertise in heart rhythm disorders. They may offer additional insights or testing options.

7. Alternative Therapies: You mentioned trying traditional Chinese medicine. While the efficacy of such treatments can vary, some individuals find relief through acupuncture or herbal remedies. It’s essential to consult with qualified practitioners and inform your primary care physician about any alternative treatments you pursue.

In conclusion, while your heart appears to be structurally normal, the symptoms you are experiencing may indeed be related to autonomic nervous system dysregulation, compounded by anxiety. Open communication with your healthcare providers about your symptoms and treatment options is crucial. With the right approach, many individuals find significant relief from their symptoms and can lead fulfilling lives. Thank you for sharing your story, and I wish you the best on your journey to better health!

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