Heart Palpitations: Is It Anxiety or Autonomic Nervous System Disorder?

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 don't need to take 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 (premature contractions?), 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 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 some 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 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 have no 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 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 detailed medical history and concerns regarding your heart palpitations and associated symptoms. It's clear that you've been through a lot, and I appreciate your openness in discussing these issues. Let's address your questions and provide some insights into the relationship between anxiety, autonomic nervous system disorders, and heart palpitations.

Understanding Heart Palpitations
Heart palpitations can manifest as a feeling of your heart racing, fluttering, or skipping beats. They can be triggered by various factors, including stress, anxiety, caffeine, medications, or underlying heart conditions. In your case, it seems that you have a history of mitral valve prolapse, which is generally considered benign but can sometimes be associated with palpitations.

Question 1: Do You Need Further Cardiac Evaluation?
Given that your previous cardiac evaluations (echocardiogram and exercise stress test) showed no significant issues, it may not be immediately necessary to undergo further cardiac testing unless your symptoms have changed significantly or you experience new concerning symptoms (such as chest pain, severe shortness of breath, or fainting). However, if your palpitations have intensified or are accompanied by dizziness and fatigue, it would be prudent to consult your cardiologist again for a thorough evaluation. They may recommend a Holter monitor (24-hour ECG) to capture your heart's activity over a longer period, especially during symptomatic episodes.

Question 2: Is It Autonomic Nervous System Disorder?
Your symptoms, including palpitations, shortness of breath, and feelings of anxiety, could indeed be related to an autonomic nervous system (ANS) disorder. The ANS regulates involuntary bodily functions, including heart rate and respiratory rate. When the ANS is out of balance, it can lead to symptoms such as palpitations, anxiety, and gastrointestinal issues, which you've experienced in the past.

Anxiety can exacerbate these symptoms, creating a feedback loop where anxiety leads to palpitations, which in turn increases anxiety. This cycle can significantly impact your quality of life, as you've noted. It's essential to recognize that while your heart may be structurally normal, the sensations you're experiencing can still be very real and distressing.

Managing Anxiety and Autonomic Nervous System Dysfunction
1. Cognitive Behavioral Therapy (CBT): Engaging in therapy can help you develop coping strategies to manage anxiety and reduce the perception of palpitations. CBT is particularly effective for anxiety disorders and can help break the cycle of fear and physical symptoms.

2. Mindfulness and Relaxation Techniques: Practices such as deep breathing, meditation, and yoga can help calm the nervous system and reduce anxiety. These techniques can also help you become more aware of your body and its responses, allowing you to manage symptoms more effectively.

3. Lifestyle Modifications: Regular exercise, a balanced diet, and adequate sleep can positively influence your overall well-being and help regulate the autonomic nervous system. Avoiding stimulants like caffeine and nicotine may also reduce palpitations.

4. Medication: If your anxiety is significantly impacting your daily life, discussing medication options with your healthcare provider may be beneficial. Selective serotonin reuptake inhibitors (SSRIs) or beta-blockers can be effective in managing anxiety and palpitations.

Conclusion
In summary, while your heart appears structurally sound, the symptoms you're experiencing may be linked to anxiety and autonomic nervous system dysfunction. It’s essential to address both the physical and psychological aspects of your condition. Regular follow-ups with your healthcare provider, combined with therapeutic interventions, can help you regain control over your symptoms and improve your quality of life. Remember, you are not alone in this journey, and seeking support is a vital step toward healing. Take care!

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I recommend that you discuss the above situation with your attending physician to determine if further examinations are necessary. Thank you, and wishing you good health!