Symptoms: Cough, Palpitations, and Gastroesophageal Reflux Issues

Regarding wheezing, coughing, phlegm, palpitations, and dry nausea?

Hello, Doctor Gao.
I currently have a symptom where cardiology tests, including myocardial perfusion, echocardiogram, and 24-hour Holter monitoring, have shown instances of premature contractions, but they remain within a safe range.
The pulmonary examination showed no abnormalities, and the gastroenterology endoscopy revealed no issues with the esophagus or cardia.
However, it was noted that even in the absence of acidic fluid, if there are symptoms of regurgitation, there may be a sensation of food taste or residue in the throat, which could indicate gastroesophageal reflux disease (GERD).
This condition may also lead to palpitations.

The symptoms I am consulting about have actually been present for seven to eight years, but I have noticed a trend of worsening in recent months.
Whenever I engage in physical activity, such as climbing stairs, brisk walking, or during moments of emotional stress or anger, the following symptoms are likely to occur sequentially and simultaneously: 1.
Mild shortness of breath 2.
Coughing (either mild or severe) 3.
Producing phlegm (clear and white; if I can cough it out, it provides significant relief; otherwise, it becomes more uncomfortable) 4.
Palpitations or a tightening sensation (in the center of the chest or radiating upwards) 5.
Dry heaving (if there is no dry heaving, the aforementioned symptoms persist; after a few episodes of dry heaving, all symptoms quickly lessen or disappear).
Pressing on the Neiguan (PC6) and Shenmen (HT7) points provides some relief.
I am truly confused about the underlying cause of these issues—whether they stem from the heart itself, the reflux problem, or emotional factors.
Below are the herbal powders prescribed by my physician: White Peony, Bitter Orange, Magnolia Bark, Dan Shen, Job's Tears, Evodia, Cardamom, Areca Nut, Longdan Decoction, and Xuefu Zhuyu Decoction.
I would appreciate your insights on this matter.
Thank you.

Mr. Zhang, 50~59 year old female. Ask Date: 2022/08/26

Dr. Gao Peiyi reply Traditional Chinese Medicine

The described symptoms may be caused by emotional issues, gastroesophageal reflux, or both.
While water spinach can alleviate angina symptoms, a daily dose of less than 2 grams usually serves more as a placebo.
Fructus Aurantii, Magnolia Bark, Coix Seed, Evodia, Cardamom, and Areca Nut are all gastrointestinal medications that help regulate Qi movement, promote Yang, and resolve dampness.
Although Danshen is a cardiovascular medication, it only has significant effects at higher doses; a powder of 1-2 grams serves merely as "maintenance." Longdan Cao Decoction is used to clear heat, drain fire, and eliminate damp-heat.
Prescribing based on constitution, Xuefu Zhuyu Decoction is used to invigorate blood and dispel stasis, which is more effective for musculoskeletal pain, but has limited effects on cardiac issues.

Reply Date: 2022/08/26

More Info

It sounds like you are experiencing a complex interplay of symptoms that may be related to gastroesophageal reflux disease (GERD), anxiety, and possibly other gastrointestinal issues. Understanding the relationship between these symptoms is crucial for effective management.

Symptoms Overview
1. Coughing and Throat Irritation: Your description of a cough, particularly when accompanied by a sensation of food or residue in the throat, is consistent with GERD. When stomach acid or contents flow back into the esophagus, it can irritate the lining and lead to symptoms such as coughing, throat discomfort, and even a sensation of a lump in the throat (often referred to as globus sensation).

2. Palpitations: The sensation of your heart skipping beats or feeling tightness in the chest can be distressing. While you have undergone thorough cardiac evaluations, it’s important to note that palpitations can sometimes be exacerbated by anxiety or stress, which may also be triggered by physical exertion or emotional responses. The vagus nerve, which plays a role in heart rate regulation, can be influenced by gastrointestinal distress, potentially linking your reflux symptoms to palpitations.

3. Shortness of Breath: This can be multifactorial. Anxiety can lead to hyperventilation, which may cause feelings of breathlessness. Additionally, if you are experiencing significant discomfort from GERD, it can lead to a sensation of tightness in the chest, mimicking shortness of breath.

4. Dry Heaving and Nausea: The act of dry heaving, especially after exertion or when feeling anxious, can be a physical response to stress or discomfort. It may also be related to the irritation of the esophagus and throat from reflux.

Potential Causes and Management
Given the chronic nature of your symptoms over the past several years, it is essential to consider both physical and psychological factors:
- Gastroesophageal Reflux Disease (GERD): Since you have been diagnosed with GERD, it is crucial to manage this condition effectively. This may include lifestyle modifications such as avoiding trigger foods (spicy, fatty, or acidic foods), eating smaller meals, and not lying down immediately after eating. Medications such as proton pump inhibitors (PPIs) or H2 blockers may also be beneficial in reducing acid production.

- Anxiety and Stress Management: Since you mentioned that symptoms worsen with emotional stress or physical exertion, addressing anxiety through cognitive-behavioral therapy (CBT), mindfulness practices, or relaxation techniques may help alleviate some of your symptoms. It might also be helpful to consult with a mental health professional who can provide strategies to manage anxiety.

- Further Evaluation: If symptoms persist despite treatment, further evaluation may be warranted. This could include esophageal motility studies to assess how well the esophagus is functioning, or a 24-hour pH monitoring study to quantify acid exposure in the esophagus.

Conclusion
In summary, your symptoms of cough, palpitations, and gastrointestinal discomfort may be interconnected, primarily through the mechanisms of GERD and anxiety. A comprehensive approach that includes lifestyle modifications, medication management, and psychological support may provide relief. It is essential to maintain open communication with your healthcare providers to tailor a treatment plan that addresses all aspects of your health. If you continue to experience significant symptoms, consider seeking a second opinion or further specialized care in gastroenterology or cardiology.

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