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 had symptoms like palpitations and shortness of breath since I was young, but I've managed to grow up with them.
Four years ago, I started experiencing premature beats (extrasystoles?), and during severe episodes, I would have more than 10 missed beats per minute.
I went to the hospital for a cardiac ultrasound and a stress test, and the doctors said there was nothing serious.
Since then, I've frequently dealt 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 rest, but more pronounced discomfort can lead me to feel down and anxious, affecting my quality of life and mood.
Recently, over the past week, the discomfort has intensified, with my heart rate reaching up 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 evaluation? (The last stress test was in April 2021, and the cardiac ultrasound 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 dysregulation? Thank you.

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

Dr. He Dongjin reply Cardiology

Hello, that's correct.
You have autonomic nervous system dysfunction, not an organic heart problem.
There's 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 potential link to autonomic nervous system dysfunction. Based on your description, it seems that you have been dealing with a variety of symptoms related to your heart for quite some time, including palpitations, shortness of breath, and feelings of anxiety.
To address your first question about whether you need to undergo further cardiac examinations, it is essential to consider a few factors. Given that your last exercise electrocardiogram (ECG) was in April 2021 and your echocardiogram was in 2018, it may be prudent to have a follow-up evaluation, especially since you are experiencing a recent increase in symptoms. While 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 heart's condition. This could include a repeat echocardiogram, a Holter monitor to assess your heart rhythm over 24 hours, or even a stress test to evaluate how your heart responds to physical exertion.

Regarding your second question about whether your symptoms could be attributed to autonomic nervous system dysfunction rather than an organic heart problem, it is indeed possible. The autonomic nervous system (ANS) regulates involuntary bodily functions, including heart rate, blood pressure, and respiratory rate. Dysregulation of the ANS can lead to symptoms such as palpitations, anxiety, and feelings of breathlessness, which you have described.
In your case, the combination of mitral valve prolapse and the symptoms you experience could suggest a heightened sensitivity of the autonomic nervous system. Stress, anxiety, and lifestyle factors such as irregular sleep patterns and sedentary behavior can exacerbate these symptoms. It is not uncommon for individuals with a history of anxiety or panic attacks to become hyper-aware of their heartbeats, leading to a cycle of anxiety and physical symptoms.

To manage your symptoms effectively, consider the following recommendations:
1. Lifestyle Modifications: Regular physical activity, such as walking or jogging, can help improve cardiovascular health and reduce anxiety. Aim for at least 150 minutes of moderate exercise each week. Additionally, practicing relaxation techniques such as deep breathing, meditation, or yoga can help calm the nervous system.

2. Sleep Hygiene: Establishing a regular sleep schedule and creating a calming bedtime routine can improve sleep quality. Avoid screens before bedtime and consider relaxation exercises to help you wind down.

3. Dietary Considerations: A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support overall health. Limiting caffeine and alcohol intake may also help reduce palpitations and anxiety.

4. Medical Management: If your symptoms persist or worsen, discussing medication options with your healthcare provider may be beneficial. Beta-blockers, for example, can help manage palpitations and anxiety symptoms.

5. Psychological Support: If anxiety is significantly impacting your quality of life, consider seeking support from a mental health professional. Cognitive-behavioral therapy (CBT) can be particularly effective in addressing anxiety and panic symptoms.

In conclusion, while your symptoms may be related to autonomic nervous system dysfunction, it is essential to rule out any underlying cardiac issues through appropriate testing. Taking proactive steps to manage stress, improve lifestyle habits, and seek medical advice will help you navigate your symptoms more effectively. Remember, you are not alone in this journey, and support is available to help you regain control over your health and well-being.

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