Heart Discomfort: Is It Autonomic Nervous System Dysfunction?

Cardiac discomfort. Autonomic nervous system dysfunction?

Hello, doctor.
I was diagnosed with mitral valve prolapse since childhood, but it hasn't been serious, and I haven't needed medication.
I've experienced palpitations and shortness of breath since I was young, but I managed to grow up with it.
Four years ago, I started experiencing premature beats (extrasystoles?), sometimes as many as ten per minute during severe episodes.
I went to the hospital for an echocardiogram and a stress test, and the doctors said there was nothing significant.
Since then, I've been frequently dealing with various heart discomforts, including palpitations, missed beats, forceful heartbeats, rapid heart rate, shortness of breath, chest tightness, and a feeling of constriction in my chest.
Mild symptoms usually resolve with a bit of rest, but more pronounced discomfort can lead to feelings of depression and anxiety, affecting my quality of life and mood.
Recently, over the past week, the discomfort has intensified, with my heart rate rising to 110 in the morning or after meals, accompanied by premature beats and dizziness.
Often, after a "battle" with these symptoms, I feel fatigued and lack appetite for the entire day.
I would like to ask the doctor: 1.
Do I need to undergo further cardiac examinations? (The last stress test was in April 2021, and the echocardiogram was in 2018, both showing no significant issues.) 2.
Should I consider that my symptoms may not be due to an organic heart problem, but rather autonomic nervous system dysfunction? Thank you.

Xiao Lin, 30~39 year old female. Ask Date: 2021/10/08

Dr. He Dongjin reply Cardiology

Hello, you indeed have autonomic nervous system dysfunction, rather than an organic heart problem.
There is no need for further cardiac examinations or to see a cardiologist or psychosomatic specialist.
Simple medications can help improve your symptoms.
Don't worry, Changhua Hospital cares about you.

Reply Date: 2021/10/08

More Info

Hello! Thank you for sharing your concerns regarding your heart discomfort and the symptoms you've been experiencing. It sounds like you've been through quite a journey with your health, particularly with your diagnosis of mitral valve prolapse and the associated symptoms of palpitations, shortness of breath, and anxiety. Let's address your questions and provide some insights into your situation.

1. Need for Further Cardiac Evaluation: Given that your last cardiac evaluations (exercise electrocardiogram and echocardiogram) were conducted in 2021 and 2018, respectively, it may be prudent to consider a follow-up assessment, especially since you are experiencing an increase in symptoms such as rapid heart rate (tachycardia), palpitations, and dizziness. While your previous tests indicated no significant issues, the emergence of new or worsening symptoms warrants a re-evaluation to rule out any potential changes in your cardiac health. A thorough examination, including an updated echocardiogram and possibly a Holter monitor to assess your heart rhythm over 24 hours, could provide valuable information.

2. Autonomic Nervous System Dysfunction: Your symptoms, particularly the heart palpitations, feelings of tightness in the chest, and anxiety, could indeed be related to autonomic nervous system (ANS) dysfunction. The ANS regulates involuntary bodily functions, including heart rate and blood pressure. Stress, anxiety, and lifestyle factors can lead to an imbalance in this system, resulting in symptoms that mimic cardiac issues. It's common for individuals with anxiety or stress to experience heightened awareness of their heartbeats, leading to a cycle of worry and increased heart rate. This can create a feedback loop where anxiety exacerbates physical symptoms, which in turn increases anxiety.

Given your history of anxiety and the impact it has on your daily life, it may be beneficial to explore strategies for managing stress and anxiety. Techniques such as mindfulness, deep breathing exercises, and regular physical activity can help regulate the autonomic nervous system and improve your overall well-being. Additionally, cognitive-behavioral therapy (CBT) has been shown to be effective in managing anxiety and can help you develop coping strategies for dealing with your symptoms.

It's also important to maintain a healthy lifestyle, including regular exercise, a balanced diet, and adequate sleep. These factors can significantly influence both your physical and mental health. Since you mentioned that your symptoms tend to worsen after meals or during periods of stress, paying attention to your diet and incorporating relaxation techniques into your routine may help alleviate some of the discomfort.

In conclusion, while your symptoms may not indicate a serious underlying cardiac condition, they are certainly affecting your quality of life. A follow-up with your healthcare provider for further evaluation is advisable, and exploring the role of the autonomic nervous system in your symptoms could provide valuable insights. Remember, you are not alone in this, and many individuals experience similar challenges. Seeking support from healthcare professionals, therapists, or support groups can also be beneficial as you navigate this journey. Take care, and I wish you the best in your health and well-being!

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