VPC and Autonomic Nervous System Disorders: A Patient's Guide

Q: VPC and Autonomic Nervous System Disorders: A Patient's Guide

Hello： If VPC is ruled out as a result of internal medicine issues, it is indeed possible that it may arise under conditions of significant psychological stress, such as panic disorder. <br>It is advisable to seek consultation with a psychiatrist and consider undergoing psychothe

Autonomic nervous system dysfunction, ventricular premature contractions (VPC)?

Hello, Dr.
Wu.
I apologize for bothering you.
I would like to ask if you have heard of VPC (ventricular premature contractions)? I experience a sensation of missed heartbeats, and my echocardiogram and thyroid blood tests have all come back normal.
However, a 24-hour Holter monitor showed 300 instances of VPCs.
The cause remains unclear, and no tests have been able to identify the reason.
A cardiologist also believes it may be due to autonomic nervous system dysregulation.
Have you encountered such a situation before? Currently, I am taking Concor 1.25 (a beta-blocker) and Deyuanxue (for autonomic nervous system support), along with Xanax as needed, which I take during episodes of rapid heartbeat and continuous missed beats due to panic.
Initially, the combination of Concor and Deyuanxue helped suppress the sensation of missed beats, but recently, the feeling has returned, significantly affecting my quality of life.
I often feel anxious and uneasy, and I have read that some people find relief with Yongkangxue and Isitan.
Would you consider prescribing such a combination? Is it common to prescribe beta-blockers for autonomic nervous system issues? Or do you have other recommendations? I really don’t know what to do; these symptoms started in June, and my quality of life has deteriorated, making me hesitant to go out.
Please help me with your insights.
Thank you!

ANDY, 20~29 year old female. Ask Date: 2020/09/21

Dr. Wu Enliang reply Psychiatry

Hello: If VPC is ruled out as a result of internal medicine issues, it is indeed possible that it may arise under conditions of significant psychological stress, such as panic disorder.
It is advisable to seek consultation with a psychiatrist and consider undergoing psychotherapy, biofeedback training, or pharmacological treatment for anxiety and depression.
Dr.
Wu En-Liang

Reply Date: 2020/09/21

More Info

Understanding Ventricular Premature Contractions (VPC) and Autonomic Nervous System Disorders: A Patient's Guide
Ventricular premature contractions (VPCs), also known as ventricular ectopic beats, are a common type of arrhythmia where the heart experiences an early heartbeat originating from the ventricles. This can lead to sensations of palpitations or a feeling of the heart "skipping a beat." While VPCs are often benign, their occurrence can be distressing, especially when accompanied by anxiety or panic attacks.

From your description, it seems that you have undergone extensive testing, including echocardiograms and blood tests, which have returned normal results. This is reassuring, as it indicates that there are no underlying structural heart issues or metabolic disturbances contributing to your VPCs. The presence of 300 VPCs over a 24-hour period, while significant, is not uncommon and can occur in individuals without any serious heart disease.

The relationship between VPCs and the autonomic nervous system (ANS) is well-documented. The ANS regulates involuntary bodily functions, including heart rate and rhythm. Dysregulation of the ANS can lead to increased sympathetic activity (the "fight or flight" response) or decreased parasympathetic activity (the "rest and digest" response), both of which can contribute to the sensation of palpitations and anxiety. Stress, anxiety, and lifestyle factors such as caffeine intake can exacerbate these symptoms.

You mentioned that you are currently taking a beta-blocker (Kankin, or propranolol) and a medication for autonomic regulation (De Yuan Xu). Beta-blockers are often prescribed to help manage symptoms associated with VPCs and anxiety by reducing heart rate and the force of contraction, which can alleviate the sensation of palpitations. However, it is not uncommon for patients to experience fluctuations in their symptoms, and it may take time to find the right combination of medications that work for you.

Regarding your concerns about the return of VPC sensations, it is essential to communicate this with your healthcare provider. They may consider adjusting your medication regimen or exploring additional treatment options. The combination of medications you mentioned, such as Yongkang Xu and Yisi Tan, may be beneficial for some patients, but the decision to prescribe these should be made by your physician based on your specific symptoms and medical history.

In terms of managing your symptoms and improving your quality of life, consider the following strategies:
1. Lifestyle Modifications: Regular exercise, a balanced diet, and adequate hydration can positively influence your overall health and help regulate your autonomic nervous system. Reducing caffeine and alcohol intake may also help minimize VPC occurrences.

2. Stress Management: Techniques such as mindfulness, meditation, and deep breathing exercises can help reduce anxiety and improve your response to stress. Cognitive-behavioral therapy (CBT) may also be beneficial in addressing anxiety and panic symptoms.

3. Monitoring: Keeping a diary of your symptoms, including when they occur and any associated triggers, can provide valuable information for your healthcare provider. This can help tailor your treatment plan more effectively.

4. Follow-Up: Regular follow-up appointments with your cardiologist or primary care physician are crucial. They can monitor your condition and make necessary adjustments to your treatment plan.

5. Education: Understanding your condition can empower you and reduce anxiety. Engaging in discussions with your healthcare provider about your concerns and treatment options can help you feel more in control.

In conclusion, while VPCs can be concerning, they are often manageable with the right approach. It is essential to maintain open communication with your healthcare provider about your symptoms and treatment options. With appropriate management, many patients find relief from their symptoms and can improve their quality of life. If you have further questions or concerns, do not hesitate to reach out to your healthcare team for guidance.

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