Is It Autonomic Dysfunction or Heart Issues? Your Symptoms

Is it an autonomic nervous system issue or a heart problem?

Hello, doctor.
About three years ago, I visited a psychosomatic specialist who diagnosed me with panic disorder.
I experienced symptoms like numbness in my hands and head, discomfort throughout my body, and rapid heartbeat in specific situations.
The doctor prescribed me with Escitalopram and a medication for heart rhythm, stating that I had panic disorder.
I only took the heart rhythm medication for two weeks and continued with Escitalopram for nearly a year before discontinuing it without any relapse.
Last year, in my pursuit of pregnancy, I consulted a traditional Chinese medicine practitioner who performed acupuncture on me, inserting about ten needles.
Within a minute of the needles being placed, my heart rate skyrocketed, and I felt faint and as if I might die, prompting me to ask the doctor to remove the needles.
After the needles were taken out, my heart rate calmed down.
However, two hours later, my heart rate surged again, leading me to the emergency room.
Before both instances of rapid heartbeat, I experienced tingling in my calves, as if I were about to cramp, followed by numbness in my head.
In the emergency room, the doctor administered Clonazepam, the heart rhythm medication, and a sedative, which made me feel much better.

Subsequently, I underwent cardiac examinations, including an echocardiogram and a 24-hour Holter monitor, which showed no significant abnormalities.
I also felt that month had minimal palpitations.
The doctor mentioned I had mild mitral valve regurgitation, which is common and does not require medication or concern.
Blood tests indicated I was iron deficient, possibly due to anemia, so I was prescribed iron supplements.

I still occasionally experience sudden increases in heart rate, which are uncomfortable, and I feel tense throughout my body whenever I am awake.
I later visited another psychosomatic specialist who confirmed I had autonomic nervous system dysfunction.
He prescribed a medication similar to Escitalopram but from a different brand, which I vaguely recall was called Anxiolytic.
After taking one pill, I felt extremely uncomfortable within half an hour—numbness in my head, nausea, palpitations, and I couldn't sleep all night, so I stopped taking it.
Eventually, I consulted another traditional Chinese medicine practitioner and mentioned the issues I experienced with acupuncture.
He indicated that my constitution is very sensitive and not suitable for acupuncture.
He diagnosed me with severe autonomic nervous system dysfunction and noted that my habitual slouching could lead to heart problems and chest tightness.
At that time, I was indeed in a constant state of tension and felt very uncomfortable.
The Chinese medicine doctor prescribed various calming and spleen-strengthening medications, which helped me relax significantly.
After about a month of herbal treatment, my condition stabilized, but I still occasionally experienced sudden anxiety leading to palpitations, though not frequently.
However, yesterday at work, I suddenly experienced a rapid heartbeat (similar to the sensations I felt during acupuncture and in the emergency room, which is different from anxiety-induced palpitations).
It lasted for a few seconds and then subsided, but since then, I've felt a tightness in my chest, as if something is pressing down, especially when I move my body, such as bending over.
I also began to feel tension in my back.
My father mentioned that he used to experience sudden increases in heart rate and dizziness, and after various tests failed to identify the issue, he underwent a cardiac catheterization, which revealed an additional line near his heart that caused the rapid heartbeat when it made contact.
They cauterized it, and he was fine afterward, so he suggested I consider a cardiac catheterization as well.
I am very concerned about whether this is a heart issue, but if it were, wouldn't I also experience muscle tension? I researched cardiac catheterization and feel that the procedure would trigger my panic attacks because I panic when I am forced to stay in one position without movement (like during cosmetic laser treatments or watching movies), leading to palpitations, so I am hesitant to undergo this examination.
I also learned online that gastrointestinal issues can cause chest tightness and palpitations.
I haven't had my stomach checked, but I have long experienced belching, which I thought was due to diaphragm spasms and didn't pay much attention to, especially after meals.
After taking Chinese medicine, my condition improved, but I still occasionally feel a sense of tightness in my stomach (which I can't quite describe).
Other than that, my stomach seems fine.
I want to ask the doctor where my issues lie...
Is it truly a problem with my autonomic nervous system, or is it accompanied by panic disorder? Do I need to undergo an endoscopy? If my electrocardiogram and echocardiogram show no issues, can we temporarily rule out heart problems? Why does acupuncture trigger my rapid heartbeat? All these symptoms began after I started acupuncture...

Niming, 30~39 year old female. Ask Date: 2021/05/13

Dr. Cai Zongzhang reply Neurology

Hello! It is recommended to visit a neurologist for an examination.

Reply Date: 2021/05/13

More Info

Based on your detailed description, it seems that you are experiencing a complex interplay of symptoms that may be attributed to both autonomic dysfunction and potential heart-related issues. Let's break down your concerns and symptoms to provide a clearer understanding.

Autonomic Dysfunction vs. Heart Issues
1. Autonomic Dysfunction: This condition often manifests as symptoms like rapid heartbeat, feelings of anxiety, and physical sensations such as tingling or numbness. Your history of panic attacks and the symptoms you experienced during acupuncture suggest that your autonomic nervous system may be overly sensitive. This can lead to exaggerated responses to stressors, including physical sensations that mimic heart problems.

2. Heart Issues: You mentioned undergoing various heart tests, including echocardiograms and 24-hour Holter monitoring, which returned normal results aside from mild mitral regurgitation. This finding is common and often benign, especially if you are asymptomatic. The absence of significant heart abnormalities in your tests suggests that serious heart conditions are less likely.

Symptoms and Their Implications
- Chest Tightness and Rapid Heartbeat: These symptoms can be associated with anxiety and panic attacks. The fact that you have experienced these symptoms during stressful situations (like acupuncture) supports this idea. It's also possible that your body's response to stress is causing physical symptoms that feel like heart issues.

- Gastrointestinal Symptoms: You mentioned experiencing bloating and discomfort after eating, which could indicate gastrointestinal issues such as gastroesophageal reflux disease (GERD) or functional dyspepsia. These conditions can also contribute to feelings of chest discomfort and palpitations, especially after meals.

- Tension and Posture: Your mention of being habitually hunched over could lead to muscle tension, which may contribute to feelings of tightness in the chest and back. Poor posture can affect breathing and lead to increased anxiety, further exacerbating your symptoms.

Recommendations
1. Continued Monitoring: Since your heart tests have been normal, it may be beneficial to continue monitoring your symptoms without immediate invasive procedures like cardiac catheterization. If your symptoms persist or worsen, a follow-up with a cardiologist may be warranted.

2. Addressing Anxiety: Given your history of panic attacks, working with a mental health professional to address anxiety and panic symptoms could be beneficial. Cognitive-behavioral therapy (CBT) is particularly effective for managing anxiety disorders.

3. Lifestyle Modifications: Incorporating regular exercise, mindfulness practices, and stress-reduction techniques can help manage both anxiety and physical symptoms. Additionally, maintaining a healthy diet and addressing any gastrointestinal issues with a healthcare provider may improve your overall well-being.

4. Avoiding Triggers: If acupuncture has previously triggered your symptoms, it may be wise to avoid it or discuss alternative therapies with your healthcare provider.

5. Gastrointestinal Evaluation: If you continue to experience gastrointestinal symptoms, consider discussing the possibility of a gastroenterology evaluation to rule out conditions like GERD or other digestive issues.

Conclusion
In summary, while your symptoms are concerning, the absence of significant findings on cardiac evaluations suggests that autonomic dysfunction and anxiety may play a significant role in your experiences. It is essential to address both the physical and psychological aspects of your health to achieve a comprehensive understanding and management of your symptoms. Regular follow-ups with your healthcare providers will be crucial in navigating your health journey.

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