Autonomic Nervous System Disorders: Symptoms and Treatment Insights

Autonomic Nervous System Dysfunction

Hello Doctor, I recently experienced what I suspect was a panic attack, which led to a sensation of heart palpitations (normal rate) while sitting or lying down throughout the day, affecting my sleep.
I underwent an echocardiogram, a 24-hour Holter monitor, and a cardiac CT scan, all of which indicated that my heart is in good condition.
Later, I consulted a psychiatrist and had my heart rate variability (HRV) measured, which revealed issues with autonomic nervous system dysregulation.

(1) I would like to ask if cases of autonomic nervous system dysregulation can lead to sensations of heart palpitations while sitting or lying down throughout the day? I am currently on medication (including antiarrhythmic drugs, anxiolytics, and other medications).

(2) Additionally, I would like to inquire about my current situation.
I have been on medication for nearly 9 months now, and while my condition has improved, I still experience fluctuations in symptoms.
Is this normal? Thank you for your response, Doctor.

Mr. Lin, 30~39 year old female. Ask Date: 2022/11/16

Dr. Li Guanying reply Psychiatry

Dear Sir/Madam,
From your letter, it is evident that you are experiencing discomfort and distress due to your panic disorder and sleep-related issues.

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

2.
Autonomic nervous system dysregulation (panic disorder) is a chronic condition characterized by episodes of exacerbation, remission, recovery, and relapse.
More than half of patients may experience a recurrence of symptoms even after they have subsided.
Due to individual differences in physiology, it may take time to identify the appropriate medication, so please be patient and collaborate with your physician.
3.
In terms of pharmacological treatment, each primary medication requires 4 to 6 weeks to assess its efficacy.
If you experience any discomfort, please note the duration and frequency of these symptoms.
4.
In addition to medication and psychotherapy, repetitive transcranial magnetic stimulation (rTMS) is a non-invasive, anesthesia-free, highly safe treatment option that does not require hospitalization and can improve anxiety and depressive symptoms.
Please discuss any psychosomatic issues thoroughly with your physician during your follow-up appointment, 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 recommend that you 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.
Kuan-Ying Lee
Department of Psychiatry

Reply Date: 2022/11/16

More Info

Autonomic Nervous System (ANS) disorders can indeed manifest in various ways, and your experience aligns with common symptoms associated with these conditions. The autonomic nervous system is responsible for regulating involuntary bodily functions, including heart rate, blood pressure, and digestion. It consists of two main branches: the sympathetic nervous system, which prepares the body for 'fight or flight' responses, and the parasympathetic nervous system, which promotes 'rest and digest' activities.
1. Symptoms of Autonomic Nervous System Disorders:
Your description of experiencing a racing heart while sitting or lying down, particularly after a panic attack, is not uncommon in individuals with ANS disorders. This can be attributed to heightened sympathetic nervous system activity, which may persist even in restful states. Symptoms can include palpitations, anxiety, sweating, and gastrointestinal disturbances. The sensation of your heart racing, despite normal heart function as confirmed by your cardiac evaluations, suggests that your body may be in a state of heightened arousal or anxiety, which is characteristic of autonomic dysregulation.

2. Treatment and Medication:
You mentioned that you have been on medication for about nine months, including heart rhythm medications and anxiolytics. It is important to understand that treatment for ANS disorders often requires a multi-faceted approach. While medications can help manage symptoms, they may not always provide a complete resolution. It is not unusual for patients to experience fluctuations in their symptoms, as you described. This variability can be influenced by stress, lifestyle factors, and the nature of the disorder itself.
The medications you are taking, such as anxiolytics, can help alleviate anxiety and improve overall well-being, but they may take time to reach their full effect. It is also essential to have regular follow-ups with your healthcare provider to assess the effectiveness of your treatment plan and make necessary adjustments.
3. Lifestyle Modifications:
In addition to pharmacological treatment, lifestyle modifications can play a crucial role in managing ANS disorders. Techniques such as cognitive-behavioral therapy (CBT), mindfulness, and relaxation exercises can help reduce anxiety and improve your overall mental health. Regular physical activity, a balanced diet, and adequate sleep are also vital in supporting autonomic function.
Furthermore, practices like deep breathing exercises, yoga, and meditation can help activate the parasympathetic nervous system, promoting relaxation and reducing the symptoms of anxiety and palpitations.
4. Monitoring and Follow-Up:
Since you have been experiencing symptoms that fluctuate, it is advisable to keep a symptom diary. Documenting when symptoms occur, their intensity, and any potential triggers can provide valuable insights for your healthcare provider. This information can help tailor your treatment plan more effectively.

In conclusion, your experiences with autonomic nervous system dysregulation and the associated symptoms are valid and not uncommon. Continuous communication with your healthcare provider is crucial to navigate this condition effectively. Remember that recovery can be a gradual process, and it is essential to be patient with yourself as you work towards managing your symptoms. If you have concerns about your current treatment or if your symptoms worsen, do not hesitate to reach out to your healthcare provider for further evaluation and support.

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