Autonomic Nervous System Disorders and Anxiety Symptoms

Autonomic nervous system dysfunction?

Hello Doctor, I was born in Hong Kong and noticed that your website in Taiwan has a lot of information about this symptom, so I specifically came to consult you.
In the past few months, I have started to experience palpitations and an increased heart rate (110-120 beats per minute), along with a vague discomfort that is hard to describe.
My anxiety has increasingly focused on my heart.
In May, I was hospitalized for cardiac examinations, including echocardiography, CT scans, and two 24-hour Holter monitor tests, as well as X-rays.
The cardiologist found no issues; all cardiac vessels and structures were normal, heart function was ideal, and the 24-hour Holter monitor showed only a slightly elevated heart rate (especially during positional changes).
Thyroid tests were normal, and lipid and cholesterol levels were also normal.
In summary, the cardiologist could not identify any other causes, and his reassurances did not alleviate my concerns.
I wonder if doctors in Hong Kong are unfamiliar with the term autonomic nervous system dysfunction? In fact, I had these symptoms 10 years ago, but they have worsened recently.
Ten years ago, my ECG showed a rapid heart rate but was otherwise normal, leading to a referral to psychiatry.
I have been on a serotonin medication (sertraline) since then, currently taking two pills, but I still experience palpitations and anxiety, which are quite recurrent.
I would like to ask the doctor: 1) Am I experiencing autonomic nervous system dysfunction or anxiety disorder? 2) If so, should I ask my doctor to switch to another serotonin medication since I am already taking two sertraline? 3) I often see a term online called "cardiac neurosis"; is it the same as autonomic nervous system dysfunction? Thank you.

Mr. Yu, 30~39 year old female. Ask Date: 2020/08/21

Dr. Xue Gengming reply Psychiatry

I recommend that you discuss the above situation with your attending physician to determine if further examinations are necessary.
Thank you, and wishing you good health!

Reply Date: 2020/08/21

More Info

Hello! Thank you for reaching out with your concerns regarding autonomic nervous system disorders and anxiety symptoms. Based on your description, it seems you are experiencing a combination of symptoms that could indeed be related to autonomic nervous system dysfunction, commonly referred to as dysautonomia, and anxiety disorders.

1. Autonomic Nervous System Dysfunction and Anxiety: The autonomic nervous system (ANS) regulates involuntary bodily functions, including heart rate, digestion, and respiratory rate. Dysautonomia can manifest as symptoms such as palpitations, rapid heart rate (tachycardia), and feelings of anxiety or panic. Given that your heart has been thoroughly evaluated and found to be structurally normal, it is plausible that your symptoms are linked to dysautonomia or anxiety rather than a primary cardiac issue. Anxiety can exacerbate the perception of physical symptoms, leading to a cycle where anxiety increases heart rate and discomfort, which in turn heightens anxiety.

2. Medication Considerations: You mentioned that you are currently taking sertraline, a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for anxiety and depression. While SSRIs can be effective, they may take several weeks to show their full effects, and not all patients respond the same way. If you continue to experience significant anxiety and palpitations despite being on sertraline, it may be worth discussing with your psychiatrist the possibility of adjusting your dosage or trying a different medication. There are other classes of medications, such as benzodiazepines for short-term relief or other SSRIs and SNRIs (serotonin-norepinephrine reuptake inhibitors), that might be more effective for your specific symptoms.

3. Cardiac Neuroticism: The term "cardiac neurosis" or "cardiac anxiety" refers to the anxiety surrounding heart-related symptoms, often without any underlying heart disease. This condition can be closely related to dysautonomia, as both involve the autonomic nervous system's regulation of heart function. Patients with cardiac neurosis may experience heightened awareness of their heartbeats, leading to increased anxiety and panic attacks, similar to what you are describing. It is essential to address both the psychological and physiological aspects of your symptoms.

In summary, it is quite possible that your symptoms are a result of autonomic nervous system dysfunction exacerbated by anxiety. It is crucial to maintain open communication with your healthcare providers about your symptoms and treatment options. If you feel that your current treatment is not effective, do not hesitate to seek a second opinion or ask for a referral to a specialist who has experience with autonomic disorders or anxiety management.

Additionally, consider incorporating lifestyle changes that may help manage anxiety and improve autonomic function, such as regular physical activity, mindfulness practices, and adequate sleep. These can complement your medical treatment and contribute to overall well-being.

I hope this information helps clarify your situation and provides a path forward for managing your symptoms. Please take care of yourself, and do not hesitate to reach out for further assistance.

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