Managing Heart Rate Irregularities and Decreased Physical Fitness - Cardiology

Heart rate instability and decreased physical performance?

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Hello Doctor, I am currently facing some issues and I really don't know what to do.
I sincerely request your assistance and advice.

1.
Due to the pandemic restrictions on swimming pools from the year before to last year, I was unable to engage in my favorite swimming activity.
Additionally, I did not participate in any other forms of exercise and spent most of my time sitting indoors, rarely going out.
I also did not watch my diet and often indulged in late-night snacks.
At the end of last year, during an event, I suddenly experienced a rapid heartbeat, with my electronic wearable device showing around 110 to 120 beats per minute.
I felt very anxious at that moment and was unsure whether I should go to the emergency room.
After returning home and resting, my heart rate was still in the 90s.
I also noticed a decline in my physical stamina; I would feel a bit dizzy when climbing stairs, and my heartbeat felt more pronounced than usual.
After climbing, I experienced some gastroesophageal reflux, chest tightness, and discomfort in my throat, sometimes feeling a foreign body sensation in my throat.
2.
Consequently, I went to see a doctor.
Nine years ago, when I was about 18, I also experienced palpitations that troubled me, and I felt generally unwell.
At that time, I underwent a cardiac ultrasound and an electrocardiogram, which revealed mitral valve prolapse.
However, after about six months, I improved without realizing it, and I had no issues in the following years.
About three years ago, I felt heavy and dizzy one day, and because it felt strange, I went to the emergency room.
Upon examination, my blood pressure was 160/110, and my heart rate was also elevated.
However, after X-rays and blood tests, the doctor only prescribed me a single dose of Xanax and sent me home to rest.
Since then, throughout the end of last year and this entire year, I have been troubled by the aforementioned palpitations, noticeable decline in stamina, and gastroesophageal reflux, leading me to suspect that there might be an issue with my heart.
During this period, I consulted a cardiologist, and blood tests ruled out thyroid issues, revealing only slightly elevated uric acid at 8.1 and triglycerides at 169, while other indices were normal (low cholesterol at 103, total cholesterol at 169).
I underwent an electrocardiogram, cardiac ultrasound, and auscultation, and the doctor mentioned it could be related to mitral valve prolapse or autonomic nervous system issues, prescribing me a heart rhythm medication to take once in the morning and once at night, advising me not to worry too much.
After finishing the two-week course of medication, I stopped taking it.
3.
However, I still have many concerns because certain abnormalities have not been adequately alleviated.
For instance, I do not understand why my stamina has declined.
This decline means that I feel easily fatigued, and activities that used to be easy for me now feel laborious, causing me to become breathless or even dizzy, making it difficult to sustain any activity for long.
This has led to a vicious cycle where I prefer to stay at home, avoiding going out or exercising too much.
Sometimes, I also experience a sudden sensation in my chest, which seems to occur more frequently lately.
Another situation I have noticed is that if I talk too much, meaning if I exhale for too long, I feel very tired, my hands and feet become cold, and I seem to become more anxious.
I have also observed that my electronic wearable device shows my heart rate dropping significantly during these times of extended talking, sometimes down to the 50s or even 40s.
I have also noticed similar data after meals, even though I had not taken the heart rhythm medication for a while.
This has led me to suspect that there might be other issues, whether related to my heart or lungs, rather than just autonomic nervous system dysfunction.
Although I am unsure why my Apple Watch sometimes shows particularly low heart rates, aside from considering possible inaccuracies, I wonder what else it might indicate.
4.
Therefore, due to the aforementioned palpitations and poor exercise tolerance, with my heart rate seeming to fluctuate, I feel very troubled, and it has limited my daily activities.
To put it simply, I am afraid of dying.
I am even hesitant to take long-distance trips or engage in proper exercise.
I sincerely ask for your help in clarifying my concerns, letting me know what meaningful symptoms I should pay attention to, which direction I should seek further consultation or observation, and which worries are excessive and unnecessary.
What mindset would be best to face these discomforts? Thank you very much, Doctor!
Attached are the results of two tests conducted in the past six months:
1.
Electrocardiogram: "SINUS TACHYCARDIA, INDETERMINATE AXIS, LATE TRANSITION"
2.
Echocardiography:
- "1.
M-mode LV Ao Mitral valve IVSd: 0.7cm Aod cm E Vel 59cm/s LVIDd: 4.8cm AVD cm A Vel 37cm/s LVPWd: 0.8cm LAD cm DcT 270ms LVIDs: 3.1cm LA/Ao 0.8 E/A 1.6 EDV 106ml TDI Lat E’ 13 EF 64% E/E’ 4.6 ESV 38ml FS 35% SV 67ml
- 2.
Doppler Aortic valve Tricuspid valve Pulmonary Valve AoV Vel 63cm/s TR VP 125cm/s PV Vel 80cm/s AoV PG 1.6mmHg TR PG 6.3mmHg PV PG 2.5mmHg
- 3.
2D and color Doppler Concentric LV remodeling Preserved LV systolic function, No RWMA Preserved LV diastolic function Mitral valve prolapse Trivial MR and TR"

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Ry, 20~29 year old female. Ask Date: 2022/12/01