Which Specialist to See for Heart Palpitations and Sleep Issues?

Which specialty should I see?

Hello Doctor: Since around the middle of last month, I have been experiencing episodes of strong heartbeats and a sensation of dizziness and floating when leaning forward while standing.
Additionally, I feel a tingling sensation in my legs and an inability to settle down, which has even affected my sleep.
I visited a cardiologist, where I underwent blood tests, an echocardiogram, a 24-hour Holter monitor, X-rays, and a standard electrocardiogram.
The doctor indicated that I have mild mitral valve insufficiency and occasional arrhythmias, but they are within normal limits.
I was then referred to a neurologist, who arranged for blood tests (to check endocrine function), X-rays, and an electromyography (EMG).
Aside from some narrowing at the fifth vertebra, no other issues were found.
As of now, although the dizziness and floating sensation have lessened, my heart still sometimes beats rapidly or forcefully, and I continue to experience tingling in my legs.
My insomnia has worsened, making it difficult to fall asleep, and I wake up every two to three hours.
I truly don’t know what to do.
Please help me, thank you!

Lixiao, 20~29 year old female. Ask Date: 2021/08/25

Dr. Liao Yaopan reply Family Medicine

Hello, if all possible physiological factors have been ruled out, stress or anxiety may also be the cause.
It is advisable to seek assistance from a psychiatrist to help maintain a normal daily routine and engage in regular exercise, which is quite important.
Online consultations are not equivalent to in-person medical visits and cannot provide diagnoses or treatment recommendations.
Changhua Hospital cares about you.

Reply Date: 2021/08/25

More Info

Based on your description, it sounds like you are experiencing a combination of heart palpitations, sleep disturbances, and possibly anxiety-related symptoms. Given the complexity of your symptoms, it is essential to approach this situation holistically and consider the various specialists who can help you.

1. Cardiologist: Since you have already seen a cardiologist and undergone various tests, including echocardiograms and Holter monitoring, it seems that your heart's structural and functional aspects have been evaluated. The mild mitral valve regurgitation and occasional arrhythmias you mentioned are common findings and may not be the primary cause of your symptoms. However, if your symptoms persist or worsen, it might be worth revisiting the cardiologist for further evaluation or a second opinion.

2. Neurologist: You have been referred to a neurologist, which is appropriate given your symptoms of dizziness, the sensation of electric currents in your legs, and the possible spinal issues. The neurologist can assess for any neurological conditions that might be contributing to your symptoms, such as peripheral neuropathy or other nerve-related issues. The muscle electromyography (EMG) and nerve conduction studies can provide valuable information about the health of your nerves and muscles.

3. Psychiatrist or Psychologist: Given the significant impact of anxiety on your sleep and overall well-being, consulting with a mental health professional could be beneficial. Anxiety can manifest physically, leading to symptoms such as palpitations, restlessness, and sleep disturbances. Cognitive-behavioral therapy (CBT) is particularly effective for treating anxiety and insomnia. A psychiatrist can also evaluate whether medication might be appropriate to help manage your anxiety and improve your sleep quality.

4. Sleep Specialist: Since you are experiencing significant sleep disturbances, a sleep specialist could provide targeted interventions. They can conduct a sleep study (polysomnography) to evaluate your sleep patterns and identify any underlying sleep disorders, such as insomnia or sleep apnea, that may not have been previously diagnosed.

Recommendations for Management
- Lifestyle Modifications: Implementing good sleep hygiene practices can significantly improve your sleep quality. This includes maintaining a consistent sleep schedule, creating a relaxing bedtime routine, and ensuring your sleep environment is conducive to rest (dark, quiet, and cool). Avoiding stimulants like caffeine and nicotine, especially in the hours leading up to bedtime, can also help.

- Relaxation Techniques: Techniques such as mindfulness meditation, deep breathing exercises, and progressive muscle relaxation can help reduce anxiety and improve your ability to fall asleep. These practices can also help manage the physical sensations of anxiety, such as palpitations and restlessness.

- Physical Activity: Regular physical activity can help reduce anxiety and improve sleep quality. Aim for at least 30 minutes of moderate exercise most days of the week, but try to avoid vigorous exercise close to bedtime.

- Follow-Up Care: Keep in close contact with your healthcare providers. Regular follow-ups can help monitor your symptoms and adjust treatment plans as necessary. If you notice any new symptoms or significant changes in your condition, do not hesitate to reach out to your doctors.

In conclusion, your symptoms are multifaceted and may require a coordinated approach involving multiple specialists. By addressing both the physical and psychological aspects of your health, you can work towards achieving better overall well-being and improved sleep quality.

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