Palpitations and Anxiety: A Guide for Young Adults - Psychiatry

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Palpitations autonomic nervous system dysfunction


Hello, doctor.
I am 18 years old and currently not attending school while waiting for enrollment next year.
Recently, I have been experiencing intercostal neuralgia, sharp pain near the sternum, palpitations, tightness and discomfort in the head and neck, and difficulty breathing.
I previously underwent a 24-hour Holter monitor, auscultation, echocardiogram, color Doppler ultrasound, blood tests (thyroid function, renal function, cardiac hormones, red and white blood cells, hemoglobin), and a chest X-ray, all of which were normal.
In fact, when I reviewed the 24-hour Holter monitor report with the doctor, they dismissed my concerns, stating that I had no significant issues.
Since climbing Hehuan Mountain on October 10 and experiencing mild altitude sickness, as well as after receiving a vaccination, I have developed a fear of climbing stairs.
My heart rate increases significantly when I do, and I have started to worry about my health, constantly checking my heart to confirm its rhythm and strength.
I have been feeling anxious lately, but I stopped taking Inderal and Alprazolam two days ago.
I often search online to confirm my symptoms, and each time I find information about serious conditions like heart failure, which only increases my anxiety.
Despite having had tests done just half a month to a month ago, I continue to doubt the results and find myself trapped in this cycle of worry.
Especially since I am tall and thin with very low body fat, I can visibly see my heart beating, which makes me want to check it constantly.
When I touch my chest, it feels like my heart is beating very strongly, and I keep measuring my heart rate with my Apple Watch.
I really do not want to be a burden to those around me.
Please help me, doctor.

Mr. Chen, 10~19 year old female. Ask Date: 2021/12/16

Dr. Zhang Gengjia reply Psychiatry


Dear Sir/Madam,
From your letter, it is clear that you are experiencing discomfort and distress due to both palpitations and the stress of autonomic nervous system dysregulation.

1.
Facing an uncertain future, autonomic nervous system dysregulation is a common condition in modern society.
It is a chronic illness that requires long-term treatment for recovery.

2.
Autonomic nervous system dysregulation (anxiety disorder) is a chronic condition characterized by episodes of exacerbation, remission, recovery, and relapse.
More than half of the patients may experience a recurrence of symptoms even after they have improved.
Due to individual differences in physiology, it may take time to identify the most suitable medication, so please be patient and cooperate with your physician.
3.
Regarding pharmacological treatment, each primary medication requires 4 to 6 weeks to assess its efficacy.
If you experience any discomfort, I recommend keeping a record of the duration and frequency of your symptoms.
4.
In addition to medication and psychotherapy, repetitive transcranial magnetic stimulation (rTMS) is a non-invasive, anesthesia-free, and highly safe treatment option that does not require hospitalization, which can help improve anxiety and depressive moods.
Please discuss any psychosomatic issues thoroughly with your physician during your follow-up visit, as some symptoms may be related to the original condition, while others could be side effects of the medication.
Our clinic is open for consultations from Monday to Friday, both in the morning and afternoon.
I encourage you to consider visiting the clinic for a personal assessment of your symptoms, so we can collaboratively determine the best course of action for you.
Wishing you mental and physical well-being.
Sincerely,
Dr.
Chang Geng-Jia
General Psychiatry

Reply Date: 2021/12/16

More Info


It's understandable that you're feeling overwhelmed with the symptoms you're experiencing, especially given your age and the context of your recent health checks. Let's break down your situation and explore the relationship between anxiety and palpitations, as well as some strategies to help you manage your symptoms.

Firstly, it's important to recognize that the symptoms you're describing—intercostal pain, chest discomfort, palpitations, and feelings of tightness in the neck and head—can often be linked to anxiety. Anxiety can manifest physically in many ways, including increased heart rate, muscle tension, and even pain, which can lead to a cycle of worry and further anxiety. The fact that you've undergone extensive testing, including a 24-hour ECG, echocardiogram, and blood tests, and that all results came back normal, is a significant reassurance. It indicates that your heart is functioning well and that there are no underlying cardiac issues.

The fear of experiencing palpitations or other symptoms can lead to a heightened state of anxiety, which in turn can exacerbate those very symptoms. This is often referred to as a "vicious cycle" where anxiety leads to physical symptoms, and those symptoms further increase anxiety. Your experience of feeling your heart beating strongly and checking it frequently can create a feedback loop that intensifies your anxiety.

Here are some strategies that might help you manage your anxiety and the physical symptoms associated with it:
1. Mindfulness and Relaxation Techniques: Practices such as deep breathing, meditation, or yoga can help calm your mind and reduce physical tension. When you feel a wave of anxiety, try to focus on your breath—inhale deeply through your nose, hold for a few seconds, and exhale slowly through your mouth. This can help slow your heart rate and reduce feelings of panic.

2. Limit Information Overload: While it's natural to seek information about your symptoms, excessive searching online can lead to increased anxiety. Consider setting boundaries for yourself regarding how much time you spend researching your symptoms. Instead, focus on activities that you enjoy or that help you relax.

3. Physical Activity: Regular exercise can be a powerful tool for managing anxiety. It helps release endorphins, which are natural mood lifters. Even a daily walk can make a significant difference in how you feel.

4. Talk to Someone: Sharing your feelings with a trusted friend or family member can provide relief. If you feel comfortable, consider speaking with a mental health professional who can help you work through your anxiety and develop coping strategies.

5. Cognitive Behavioral Therapy (CBT): If your anxiety continues to be a significant issue, you might benefit from CBT, which is a structured, goal-oriented therapy that helps individuals identify and change negative thought patterns and behaviors.

6. Medication: If your anxiety is severe and persistent, discussing medication options with a healthcare provider may be beneficial. Medications such as SSRIs or benzodiazepines can help manage anxiety symptoms effectively.

7. Stay Engaged: Since you're currently not in school, try to engage in activities that interest you or hobbies that keep your mind occupied. This can help distract you from anxious thoughts and provide a sense of accomplishment.

It's crucial to remember that you're not alone in this experience. Many young adults face similar challenges, especially during transitional periods in life. The key is to find effective coping mechanisms and support systems that work for you. If your symptoms persist or worsen, please consider reaching out to a healthcare professional for further evaluation and support. Your mental health is just as important as your physical health, and seeking help is a strong and positive step forward.

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