Autonomic Nervous System Disorders After Infection

Q: Autonomic Nervous System Disorders After Infection

Hello, Bai： Thank you for your hard work! These symptoms must be quite troubling for you. <br>The symptoms you've been experiencing since September of last year are quite broad, involving the head, throat, heart, stomach, and urinary system, which likely indicate what is known as

Autonomic nervous system dysfunction

Hello Doctor: I was infected with Mycoplasma last year, and after treatment, I have been experiencing persistent discomfort in my heart.
I went to a cardiology clinic for an echocardiogram, which revealed "mitral valve prolapse and autonomic nervous system dysfunction." The doctor prescribed antiarrhythmic medication and a muscle relaxant, but after taking the muscle relaxant once, I experienced full-body weakness and near loss of bowel and bladder control, so I stopped taking it.
I only take the antiarrhythmic medication during episodes.
Since September of last year, with changes in the weather, I have developed a range of symptoms (headaches, a sensation of a foreign body in the throat, palpitations, gastroesophageal reflux, frequent urination, and loss of appetite).
During palpitations, my heart rate can reach around 145 bpm while sitting, and the episodes last for 10 to 15 minutes before stopping.
Currently, I experience mild discomfort and sharp pain in my heart daily, along with intercostal neuralgia on the right side.
Could you advise me on which specialty I should consult for further examination? Should I get X-rays, an electrocardiogram, and a thyroid function test, or should I go directly to a psychosomatic medicine specialist for treatment? So far, my heart has only been evaluated with an echocardiogram.
Thank you!

Bai, 30~39 year old female. Ask Date: 2021/02/19

Dr. Lin Mianzhang reply Psychiatry

Hello, Bai: Thank you for your hard work! These symptoms must be quite troubling for you.
The symptoms you've been experiencing since September of last year are quite broad, involving the head, throat, heart, stomach, and urinary system, which likely indicate what is known as autonomic nervous system dysfunction.
However, autonomic nervous system dysfunction is a general term, and this diagnosis is typically made only after conducting some basic examinations and assessments when no obvious cause is found.
Generally, basic examinations include blood tests, biochemical tests (such as electrolytes and liver and kidney function), endocrine evaluations (such as thyroid function), as well as cardiac assessments like electrocardiograms and echocardiograms, along with a physical examination.
If these tests do not reveal any significant issues, then a diagnosis of autonomic nervous system dysfunction may be considered.
As for mitral valve prolapse, it is actually not uncommon and usually does not cause heart or systemic discomfort.
Therefore, I recommend that you first consult a cardiologist to arrange for detailed examinations.
If the tests show no abnormalities other than mitral valve prolapse, I suggest you see a psychiatrist, as autonomic nervous system dysfunction is a condition that mental health specialists are particularly skilled in managing.
Wishing you a speedy recovery!

Reply Date: 2021/02/19

More Info

The autonomic nervous system (ANS) plays a crucial role in regulating involuntary bodily functions, including heart rate, digestion, respiratory rate, and the fight-or-flight response. Disorders of the ANS can arise from various causes, including infections, autoimmune diseases, and other medical conditions. In your case, it appears that you experienced a significant health challenge with a mycoplasma infection, which may have contributed to your ongoing symptoms.

Mycoplasma infections can lead to a range of complications, including respiratory issues and, in some cases, cardiovascular problems. The symptoms you describe—such as palpitations, gastrointestinal disturbances, and urinary frequency—are consistent with dysautonomia, a condition where the autonomic nervous system does not function properly. This can manifest as a variety of symptoms, including those affecting the heart, digestive system, and urinary tract.

Your diagnosis of mitral valve prolapse (MVP) could also be contributing to your symptoms. MVP is a condition where the mitral valve does not close properly, which can lead to palpitations and other cardiovascular symptoms. The combination of MVP and autonomic dysfunction can exacerbate feelings of anxiety and physical discomfort, leading to a cycle of symptoms that can be challenging to manage.

Given your complex presentation, it is essential to approach your care systematically. Here are some recommendations for your next steps:
1. Cardiology Consultation: Since you have a history of heart-related symptoms and MVP, a thorough evaluation by a cardiologist is warranted. They may recommend additional tests, such as a Holter monitor (to assess heart rhythm over 24-48 hours), echocardiogram, or stress testing to evaluate your heart's function and response to physical activity.

2. Neurology Evaluation: If your symptoms of autonomic dysfunction persist, a referral to a neurologist may be beneficial. They can assess for any underlying neurological conditions that may be contributing to your symptoms, including potential dysautonomia.

3. Gastroenterology Consultation: Given your gastrointestinal symptoms, a gastroenterologist can evaluate for conditions such as gastroesophageal reflux disease (GERD) or other digestive disorders that may be exacerbating your discomfort.

4. Endocrinology Assessment: Since you mentioned thyroid testing, it may be worthwhile to have a comprehensive evaluation of your thyroid function, as thyroid disorders can also contribute to heart palpitations and other systemic symptoms.

5. Psychiatric Support: If anxiety or stress is a significant factor in your symptoms, a consultation with a mental health professional may be beneficial. Cognitive-behavioral therapy (CBT) and other therapeutic approaches can help manage anxiety and improve your overall well-being.

6. Lifestyle Modifications: In addition to medical evaluations, consider lifestyle changes that can support your health. Regular exercise, a balanced diet, adequate hydration, and stress management techniques (such as mindfulness or yoga) can positively impact autonomic function and overall health.

In summary, your symptoms suggest a complex interplay between your previous infection, potential cardiac issues, and autonomic dysfunction. A multidisciplinary approach involving cardiology, neurology, gastroenterology, and mental health support will provide a comprehensive evaluation and management plan tailored to your needs. It is crucial to communicate openly with your healthcare providers about all your symptoms and concerns to ensure a thorough assessment and appropriate treatment.

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