Chest Discomfort: Autonomic Dysfunction or Heart Issues?

Autonomic nervous system dysfunction or cardiac issues?

Hello doctor, recently I have been troubled by chest tightness, shallow breathing, and a heart rate that is somewhat elevated, around 80-95 beats per minute.
At times, it feels severe enough that I struggle to catch my breath.
This situation occurs more frequently in the mornings when I feel anxious, and I have experienced insomnia.
I have ruled out hyperthyroidism, and my blood tests and chest X-ray results are normal.
The emergency physician noted that my breathing sounds normal, and the ECG showed a stable but slightly elevated heart rate without any abnormalities.
Aside from a history of hyperthyroidism (which is now well-controlled), I do not have any other chronic illnesses.
On days when I jog 3 kilometers, my heart rate is about 99, and I feel slightly tight and short of breath, but it drops to 85 after about five minutes, and my breathing feels easier post-exercise.
Currently, the doctor has prescribed anti-anxiety medication, which has resolved my insomnia, but I still feel a persistent tightness in my chest.
I'm uncertain whether this is due to stress-induced autonomic dysfunction or if there is an underlying heart issue.
Should I pursue further cardiac evaluation or consult a psychosomatic specialist?

Nìmíng, 40~49 year old female. Ask Date: 2021/06/25

Dr. Wu Xueming reply Cardiology

Many factors in daily life can contribute to this condition, such as emotions, stress, irregular sleep patterns, or excessive intake of caffeinated beverages.
It is advisable to adjust your lifestyle and engage in regular exercise.
However, if symptoms persist, it is recommended to visit a hospital for an electrocardiogram (ECG) examination.

Reply Date: 2021/06/25

More Info

Understanding chest discomfort can be quite complex, especially when distinguishing between issues related to the heart and those stemming from autonomic dysfunction or anxiety. Based on your symptoms of chest tightness, shallow breathing, and elevated heart rate (80-95 beats per minute), it is essential to consider both physiological and psychological factors.

Firstly, your symptoms occurring primarily in the morning, alongside feelings of anxiety and insomnia, suggest a potential link to autonomic dysfunction. The autonomic nervous system (ANS) regulates involuntary bodily functions, including heart rate and respiratory rate. When under stress or experiencing anxiety, the sympathetic branch of the ANS can become overactive, leading to symptoms such as increased heart rate, shallow breathing, and chest discomfort. This is often referred to as a "fight or flight" response, where the body prepares to react to perceived threats.

Your history of hyperthyroidism, although now controlled, can also contribute to feelings of anxiety and palpitations. It is good to hear that your thyroid levels are normal, as uncontrolled hyperthyroidism can exacerbate these symptoms. The fact that your lung X-ray and blood tests returned normal results is reassuring, indicating that there are no immediate respiratory or systemic issues contributing to your discomfort.

The fact that your heart rate increases to around 99 beats per minute during exercise but normalizes shortly after suggests that your cardiovascular system is functioning adequately under stress, which is a positive sign. However, the persistent feeling of chest tightness, especially when coupled with anxiety, warrants further exploration.

Given that your doctor has prescribed anti-anxiety medication and your sleep issues have improved, it indicates that your healthcare provider is addressing the psychological aspects of your symptoms. However, if the chest discomfort persists, it may be prudent to consider further cardiac evaluation. This could include a stress test or echocardiogram to assess heart function more thoroughly, especially if there is a family history of heart disease or if you have risk factors such as hyperlipidemia.

In addition to cardiac evaluations, consulting with a mental health professional could be beneficial. Cognitive-behavioral therapy (CBT) is particularly effective for anxiety and can help you develop coping strategies for managing stress and anxiety-related symptoms.
In summary, while your symptoms may be primarily related to anxiety and autonomic dysfunction, it is essential to rule out any underlying cardiac issues. A collaborative approach involving both cardiology and mental health professionals can provide a comprehensive understanding of your condition and guide you toward effective management strategies. If your symptoms worsen or new symptoms arise, do not hesitate to seek immediate medical attention.

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