Rapid Heartbeat: Heart Issues or Autonomic Nervous System Disorder?

Increased heart rate?

Hello, I was hospitalized for acute myocarditis two years ago, and after discharge, I have been continuously taking Kankun 1.25.
During that time, my resting heart rate was maintained between 50 and 60 beats per minute.
Around the end of January this year, I started experiencing a cold, and since then, my resting heart rate has been around 80, sometimes even reaching 90 to 100 beats per minute.
Even after recovering from the cold, my heart rate has remained elevated.
Additionally, my heart rate fluctuates significantly (for example, it may be 80 now, then increase to 100 in a few minutes, and then drop back to 80 shortly after).
I also noticed that the heart rate recorded by my smartwatch during sleep has varied greatly (previously between 40 and 70, now between 60 and 80).
Furthermore, I experience orthostatic hypotension (feeling dizzy when standing up), frequent palpitations (the pulse is not high but feels very strong), and occasional headaches during exercise.
Should I consider these issues as heart-related problems or autonomic nervous system disorders? What kind of examinations should I pursue?

YI, 30~39 year old female. Ask Date: 2021/02/22

Dr. Wu Xueming reply Cardiology

Many factors in daily life can contribute to this situation, such as emotions, stress, irregular sleep patterns, or excessive intake of caffeinated beverages.
It is recommended to adjust your lifestyle and engage in regular exercise.
However, if symptoms persist, it is advisable to visit a hospital for a 24-hour Holter monitor test.

Reply Date: 2021/02/22

More Info

Understanding the symptoms you are experiencing is crucial, especially given your medical history of acute myocarditis and the ongoing issues with your heart rate and autonomic nervous system. Based on the information you've provided, it seems that your symptoms could be attributed to a combination of factors, including autonomic nervous system dysregulation and possibly residual effects from your previous heart condition.

Autonomic Nervous System and Heart Rate Variability
The autonomic nervous system (ANS) is responsible for regulating involuntary bodily functions, including heart rate, blood pressure, 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). When there is an imbalance in these systems, it can lead to symptoms such as rapid heartbeat, palpitations, and fluctuations in heart rate.

Your observation of heart rates fluctuating between 80 and 100 beats per minute during rest, as well as the increased resting heart rate compared to your previous baseline, suggests that your body may be experiencing heightened sympathetic activity or reduced parasympathetic tone. This can happen due to stress, anxiety, or even physical illness, such as the recent cold you mentioned.

Postural Orthostatic Tachycardia Syndrome (POTS)
The symptoms of postural hypotension (feeling dizzy when standing up) and the rapid heart rate upon standing could indicate a condition known as Postural Orthostatic Tachycardia Syndrome (POTS). POTS is characterized by an excessive increase in heart rate when transitioning from lying down to standing up, often accompanied by symptoms like dizziness, lightheadedness, and palpitations. This condition is often related to autonomic dysfunction and can be exacerbated by dehydration, prolonged bed rest, or viral illnesses.

Heart Health Considerations
Given your history of acute myocarditis, it is essential to monitor your heart health closely. While your symptoms may primarily stem from autonomic dysfunction, it is also important to rule out any underlying cardiac issues. The fact that you experienced significant changes in your heart rate following a viral infection warrants further investigation.

Recommended Steps
1. Consult a Cardiologist: Given your history and current symptoms, it would be prudent to consult a cardiologist. They may recommend further testing, such as an echocardiogram, Holter monitor (24-hour ECG), or tilt table test, to assess your heart function and autonomic response.

2. Autonomic Function Testing: This can help determine how well your autonomic nervous system is functioning and whether there are any specific dysregulations.

3. Lifestyle Modifications: In the meantime, consider lifestyle changes that can help manage your symptoms. Staying well-hydrated, increasing salt intake (if advised by your doctor), and engaging in gentle, regular exercise can help improve blood volume and circulation, potentially alleviating some symptoms.

4. Monitor Symptoms: Keep a detailed log of your symptoms, including heart rate, blood pressure readings, and any associated symptoms (like headaches or dizziness). This information can be invaluable for your healthcare provider in diagnosing and managing your condition.

5. Mental Health Support: Given the anxiety that can accompany these symptoms, consider seeking support from a mental health professional. Techniques such as cognitive-behavioral therapy (CBT) or mindfulness can be beneficial in managing anxiety related to health concerns.

Conclusion
In summary, your symptoms could be indicative of both autonomic nervous system dysregulation and potential residual effects from your previous heart condition. It is essential to work closely with your healthcare providers to determine the underlying causes and appropriate management strategies. Regular follow-ups and monitoring will be key in ensuring your heart health and overall well-being.

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