Anxiety and Discomfort: A Neurology Perspective

Q: Anxiety and Discomfort: A Neurology Perspective

Hello, Ms. <br>Jan： It is recommended to visit the neurology and psychiatry outpatient clinics for examination and treatment.

Anxiety and multiple discomforts?

I have mitral valve prolapse, and my doctor prescribed medication for palpitations, which helped a lot.
The doctor didn't mention the need for a follow-up appointment, so I stopped taking the medication after finishing it.
However, about a month later, I experienced palpitations again, with my heart rate exceeding 100 beats per minute.
I thought it might be related to my menstrual cycle since the cardiologist had already seen me and didn't ask for a follow-up.
After undergoing tests, the doctor informed me that typically, premenstrual symptoms would not only include palpitations but also headaches, lower abdominal pain, etc.
The doctor also performed a pelvic X-ray, which showed no issues, so it wasn't related to my menstrual cycle.

When I returned home, my father gave me the palpitations medication, and I felt much better without any side effects.
However, I wondered if it was due to anxiety or something else, as I had become more anxious since receiving my second dose of the BNT vaccine on December 22.
I even experienced two weeks of low mood, during which I would cry uncontrollably, sometimes five to six times a day, feeling generally unwell.
Despite others saying there was nothing wrong, I felt helpless.
The crying episodes were brief, but I eventually sought counseling, which helped me improve gradually.

Recently, I have had a couple of nights without an appetite, and one night I experienced hiccups, along with some acidic liquid and a bit of food coming back up.
After taking some antacids, I felt much better.
Sometimes, I feel a strange sensation in my left chest—not pain, but discomfort.
However, it doesn't seem to significantly affect my daily life.
I have seen many doctors recently, as I had phlegm in my throat, but the doctor prescribed a three-day course of medication, which I finished without improvement.
I went back for a follow-up and took one or two more packets of medication, and now I feel much better.

I wonder if this is related to my emotions because I usually feel worse when I am anxious or stressed.
However, there are times when I feel unwell for no apparent reason.
I find it hard to control my unwarranted worries, checking daily for any discomfort and whether it corresponds to any illness.
Recently, I started experiencing tinnitus again, which makes me feel uneasy.

Miss Zhan, 10~19 year old female. Ask Date: 2022/01/31

Dr. Cai Zongzhang reply Neurology

Hello, Ms.
Jan: It is recommended to visit the neurology and psychiatry outpatient clinics for examination and treatment.

Reply Date: 2022/01/31

More Info

Understanding anxiety and its associated physical symptoms can be quite complex, especially when considering the interplay between psychological and physiological factors. Your experience with mitral valve prolapse and subsequent episodes of palpitations, anxiety, and discomfort highlights a common scenario where emotional distress manifests as physical symptoms.

Mitral valve prolapse (MVP) is a condition where the valve between the heart's left atrium and left ventricle doesn't close properly, which can lead to palpitations and sometimes anxiety. It's important to note that while MVP can cause physical symptoms, anxiety can exacerbate these feelings, creating a cycle of discomfort. The heart can react to stress and anxiety by increasing heart rate, which you have experienced with your heart rate reaching over 100 beats per minute.

Your observation that symptoms like palpitations can coincide with your menstrual cycle is also valid. Hormonal fluctuations can influence mood and anxiety levels, which may contribute to the physical sensations you are experiencing. However, it is crucial to differentiate between symptoms that are purely physiological and those that may be influenced by psychological factors.

The anxiety you described following your second dose of the BNT vaccine is not uncommon. Vaccinations can sometimes lead to heightened anxiety or emotional responses, particularly in individuals who may already be predisposed to anxiety disorders. The feelings of helplessness and the physical manifestations of anxiety, such as crying spells and gastrointestinal discomfort, can be distressing and may require attention.

Your experience with gastrointestinal symptoms, such as loss of appetite and acid reflux, can also be linked to anxiety. Stress and anxiety can lead to increased stomach acid production and changes in gut motility, resulting in discomfort. The fact that you have sought help from a counselor indicates a proactive approach to managing your mental health, which is commendable.

It's essential to recognize that anxiety can lead to a range of physical symptoms, including but not limited to:
1. Cardiovascular Symptoms: Palpitations, increased heart rate, and chest discomfort.

2. Gastrointestinal Symptoms: Nausea, loss of appetite, and gastrointestinal reflux.

3. Neurological Symptoms: Tension headaches, dizziness, and ear ringing (tinnitus).

4. Musculoskeletal Symptoms: Muscle tension and discomfort.

Given the complexity of your symptoms, it may be beneficial to continue monitoring your physical health while also addressing your mental health. Engaging in relaxation techniques, such as mindfulness, deep breathing exercises, or yoga, can help manage anxiety levels. Regular physical activity is also known to reduce anxiety and improve overall well-being.

If your symptoms persist or worsen, it would be wise to consult with a healthcare professional who can provide a comprehensive evaluation. This may include a referral to a mental health specialist who can help you explore cognitive-behavioral therapy (CBT) or other therapeutic modalities that can effectively address anxiety.

In summary, your symptoms may be a combination of physiological responses to mitral valve prolapse and psychological factors related to anxiety. Understanding this interplay is crucial for effective management. Continue to seek support from healthcare professionals, and don't hesitate to advocate for your health needs. It’s important to address both the physical and emotional aspects of your well-being to achieve a balanced state of health.

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