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 consulted a psychiatrist who diagnosed me with panic disorder.
I experience symptoms like numbness in my hands and head, discomfort throughout my body, and increased heart rate in specific situations.
The doctor prescribed me with Escitalopram and a medication for heart rhythm, stating that I have 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 preparation for pregnancy, I visited a traditional Chinese medicine practitioner who performed acupuncture on about ten points on my body.
Less than a minute after the needles were inserted, my heart rate spiked, and I felt faint and as if I might die.
I quickly asked the practitioner to remove the needles, and my heart rate calmed down afterward.
However, two hours later, my heart rate spiked again, prompting me to go to the emergency room.
Before both instances of increased heart rate, 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 Lorazepam and the heart rhythm medication, which made me feel much better.

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

Despite this, I still occasionally experience sudden increases in heart rate or strong heartbeats, which are uncomfortable.
I feel tense throughout my body whenever I am awake.
Later, I consulted another psychiatrist who confirmed I have autonomic nervous system dysregulation.
He prescribed a different brand of medication similar to Escitalopram, which I think 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 returned to the traditional Chinese medicine practitioner and mentioned the issues I had during acupuncture.
He informed me that my constitution is very sensitive and not suitable for acupuncture.
He diagnosed me with severe autonomic nervous system dysregulation 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 practitioner prescribed various calming and spleen-strengthening herbal medications, which helped me relax significantly.
After about a month of herbal treatment, my condition stabilized, but I still occasionally experience sudden anxiety leading to palpitations, though not frequently.
However, yesterday at work, I suddenly experienced a rapid heartbeat (similar to the sensations I had during acupuncture and in the emergency room, which felt different from anxiety-induced palpitations).
It lasted for a few seconds and then subsided, but since then, I have felt a tightness in my chest, as if something is pressing down on it, especially when I move, 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 yielded no results, he underwent a cardiac catheterization that 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 worried 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 a panic attack, as I tend to panic when forced to remain in one position without movement (like during cosmetic laser treatments or watching movies).
Therefore, I am hesitant to undergo this examination.
I also learned online that gastrointestinal issues can lead to chest tightness and palpitations.
I haven't had my stomach checked, but I have a long-standing tendency to burp, which I initially thought was due to diaphragm spasms and didn't pay much attention to, especially after meals.
After starting herbal treatment, my condition improved, but I still occasionally feel a vague tightness in my stomach (which is hard to describe).
Other than that, my stomach seems fine.
I would like to ask the doctor what my issues might be.
Is it truly a problem with my autonomic nervous system, or could it also be accompanied by panic disorder? Should I consider undergoing an endoscopy? If my electrocardiogram and echocardiogram show no issues, can we temporarily rule out heart problems? Why did acupuncture trigger my increased heart rate? All these symptoms began after the acupuncture treatment...

Niming, 30~39 year old female. Ask Date: 2021/05/14

Dr. Cai Zongzhang reply Neurology

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

Reply Date: 2021/05/14

More Info

Based on your detailed description, it seems that you are experiencing a complex interplay of symptoms that could be attributed to both autonomic dysfunction and potential heart issues. However, given the extensive evaluations you've undergone, including echocardiograms and 24-hour Holter monitoring that have returned normal results, it is reasonable to lean towards autonomic dysfunction as the primary concern.

Understanding Autonomic Dysfunction
Autonomic dysfunction, often associated with anxiety and panic disorders, can manifest through a variety of symptoms, including palpitations, chest tightness, and feelings of unease. The autonomic nervous system (ANS) regulates involuntary bodily functions, including heart rate, blood pressure, and digestion. When the ANS is out of balance, it can lead to symptoms such as:
- Palpitations: A sensation of a racing or pounding heart, which can be exacerbated by stress or anxiety.

- Chest Discomfort: This can feel like tightness or pressure and is often linked to anxiety rather than a cardiac issue, especially in younger individuals with no significant heart disease.

- Dizziness and Lightheadedness: These symptoms can occur during episodes of heightened anxiety or panic, often leading to a fear of serious health issues.

The Role of Anxiety and Panic Attacks
Your history of panic attacks and anxiety is significant. Panic attacks can cause a surge of adrenaline, leading to increased heart rate, sweating, and a feeling of impending doom. The symptoms you describe, such as feeling faint or having a racing heart after acupuncture, could be related to a panic response triggered by the treatment or the environment.

The Impact of Lifestyle Factors
Your lifestyle habits, such as irregular sleep patterns and prolonged periods of inactivity, can exacerbate symptoms of autonomic dysfunction. Stress management techniques, regular physical activity, and a consistent sleep schedule can help mitigate these symptoms.

Gastrointestinal Factors
You mentioned experiencing gastrointestinal symptoms, such as bloating and discomfort, which could also contribute to your overall feeling of unease. The gut-brain connection is well-documented, and gastrointestinal issues can lead to or worsen anxiety symptoms. It may be worthwhile to explore dietary changes or consult a gastroenterologist if these symptoms persist.

Recommendations
1. Consult a Specialist: If you continue to experience significant symptoms, consider consulting a cardiologist for further evaluation, even if previous tests were normal. A second opinion can provide reassurance and clarity.

2. Therapeutic Approaches: Cognitive-behavioral therapy (CBT) has proven effective for managing anxiety and panic disorders. It may help you develop coping strategies for your symptoms.

3. Lifestyle Modifications: Focus on regular exercise, a balanced diet, and good sleep hygiene. These changes can have a profound impact on both physical and mental health.

4. Mindfulness and Relaxation Techniques: Practices such as yoga, meditation, or deep-breathing exercises can help reduce anxiety and improve your overall sense of well-being.

5. Monitor Symptoms: Keep a diary of your symptoms, noting when they occur and any potential triggers. This can help you and your healthcare provider identify patterns and develop a tailored treatment plan.

Conclusion
While your symptoms are concerning, the absence of significant cardiac abnormalities in your tests suggests that autonomic dysfunction and anxiety may be the primary culprits. It is essential to address both the physical and psychological aspects of your health. By working closely with your healthcare providers and making lifestyle adjustments, you can improve your quality of life and reduce the frequency and intensity of your symptoms. Remember, you are not alone in this journey, and support is available.

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