Autonomic Nervous System Disorders: Symptoms and Treatments

Autonomic nervous system dysfunction

Hello, Doctor.
Two years ago, after a meal, I began experiencing palpitations and arrhythmias.
These symptoms have continued to occur intermittently over the past two years.
The most common triggers are: 1.
Discomfort in the chest during or after eating, especially when feeling about 80% full; 2.
Feeling like my heart skips a beat or palpitates during slight emotional fluctuations.
I have been under follow-up care in cardiology for two years, and the doctor has stated that my heart function is normal and it may be psychogenic.
At the same time, I often experience acid reflux, a sensation of a foreign body in my throat, and indigestion.
An endoscopy revealed mild gastroesophageal reflux disease (GERD), and I have been treated with medication for 1-2 months at a time, but the symptoms recur after stopping the medication, leading to repeated use.

I tend to be more anxious and nervous by nature, and there is a family history of sudden cardiac death.
A month before my symptoms began, a second family member passed away suddenly (cause unknown), which, combined with the intermittent palpitations and arrhythmias, has made me fearful of being alone.
I have been gradually trying to manage my personality, but sometimes when I experience arrhythmias, I don't feel anything unusual.

Currently, my medication regimen includes: 1.
Taking half a tablet of Listril when I feel chest discomfort and self-adjustment does not provide relief; 2.
For more alarming sudden symptoms: persistent chest discomfort that does not improve, followed by dizziness and a sensation of hypoxia, after which my heart rate accelerates and feels irregular.
When my heart rate exceeds 120 beats per minute, I take an additional Inderal.
I have not yet consulted a psychiatrist, and I only take Listril when prescribed by my cardiologist for discomfort, with a frequency of sometimes 3-4 times a week, or once every 1-2 weeks.

I would like to ask the doctor if these symptoms could be due to autonomic nervous system dysfunction, and what further treatment options are available.
Thank you.

Luó, 40~49 year old female. Ask Date: 2022/12/10

Dr. Li Jite reply Psychiatry

Greetings Rose, it seems you have been through a lot of discomfort over the past two years.
You have sought medical advice, and during follow-ups and examinations, we were informed that there are no significant issues with your "body," meaning your "organs and physiology." However, the discomfort persists intermittently, leading to a growing lack of confidence in your health and even a fear of potentially severe and unpredictable situations arising at any moment.

On the other hand, Rose, you are quite observant.
We have noticed that certain life experiences and psychological factors seem to be related to this discomfort.
In fact, the situation described above resembles a classic presentation of "autonomic nervous system dysfunction." This term refers to a condition where certain causes, often psychological factors, lead to instability in the autonomic nervous system, which coordinates organ and physiological functions, resulting in various physical symptoms that are disproportionate to the actual discomfort experienced.
It is somewhat akin to an automated factory where all machines are functioning well, but the central computer responsible for automation is malfunctioning, causing the factory to fail in normal production and triggering alarms everywhere.
Currently, we more commonly refer to such conditions as "psychosomatic disorders," where the interplay between the body and mind is disrupted, leading to distress.
Upon further investigation, we may find that underlying psychological health issues, such as depression or anxiety disorders, are hidden behind these physical and mental discomforts.

In terms of treatment, psychosomatic disorders can be quite complex.
The first step is to find an expert who can help clarify the nature of the discomfort, after which we can discuss treatment options in more detail.
Therefore, it is advisable to seek assistance from a psychosomatic medicine specialist or psychiatrist.

In summary, the issues you mentioned, Rose, are indeed likely related to "autonomic nervous system dysfunction." I recommend consulting a psychosomatic medicine specialist or psychiatrist for further clarification.
If it is confirmed to be a psychosomatic disorder, we can then discuss treatment options.
However, one thing you can keep in mind is that although the discomfort persists, the current medical examinations indicate that there are no significant issues with your body, so there is no need to worry about more severe conditions at this time.
What may be lacking is a shift in the focus of your medical care, and there will certainly be a turning point! Wishing you peace and safety!

Reply Date: 2022/12/10

More Info

Understanding autonomic nervous system (ANS) disorders is crucial, especially when symptoms like palpitations, irregular heartbeats, and gastrointestinal discomfort arise. Based on your description, it seems that you are experiencing a combination of symptoms that could indeed be linked to ANS dysfunction, particularly given the context of anxiety and stress.

The autonomic nervous system is divided into 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. When there is an imbalance in these systems, it can lead to various physical symptoms, including those you are experiencing.

Your symptoms of palpitations and irregular heartbeats, especially after eating or during emotional stress, suggest that your sympathetic nervous system may be overactive in these situations. This can be exacerbated by anxiety, which is often linked to heightened sympathetic activity. The fact that you have a family history of sudden cardiac events may also contribute to your anxiety, leading to a cycle of stress and physical symptoms.

Additionally, the gastrointestinal symptoms you mentioned, such as acid reflux and a sensation of a foreign body in the throat, can also be manifestations of ANS dysfunction. The vagus nerve, which is a key component of the parasympathetic nervous system, plays a significant role in regulating heart rate and digestive functions. When the vagus nerve is not functioning optimally, it can lead to both cardiac and gastrointestinal symptoms.

In terms of treatment, it is essential to address both the physical and psychological aspects of your condition. Here are some strategies that may help:
1. Cognitive Behavioral Therapy (CBT): This form of therapy can help you manage anxiety and develop coping strategies for dealing with stress. It can also help you reframe your thoughts about your symptoms, reducing the fear associated with them.

2. Lifestyle Modifications: Incorporating regular physical activity, practicing relaxation techniques such as deep breathing, yoga, or meditation can help balance the autonomic nervous system. These practices promote parasympathetic activity, which can alleviate symptoms.

3. Dietary Changes: Since you experience symptoms after eating, consider keeping a food diary to identify any specific triggers. Eating smaller, more frequent meals and avoiding known irritants (like caffeine, spicy foods, or alcohol) may help reduce gastrointestinal symptoms.

4. Medication Management: You mentioned using medications like Listru and Inderal. It’s important to work closely with your healthcare provider to ensure that your medication regimen is appropriate for your symptoms. If you find that your current medications are not effective, discussing alternatives or adjustments with your doctor may be beneficial.

5. Regular Follow-ups: Since you have been monitored by a cardiologist, it’s crucial to maintain regular follow-ups to ensure that your heart health is stable. If symptoms persist or worsen, further evaluation may be necessary.

6. Mindfulness and Stress Reduction: Techniques such as mindfulness meditation can help reduce anxiety and improve your overall sense of well-being. This can be particularly helpful in managing the physical symptoms associated with anxiety.

In conclusion, while your symptoms may be indicative of autonomic nervous system dysfunction, they are also closely tied to anxiety and stress. A comprehensive approach that includes psychological support, lifestyle changes, and careful monitoring of your physical health can help you manage your symptoms effectively. It may also be beneficial to consult with a specialist in psychosomatic medicine or a psychologist who specializes in anxiety disorders to gain further insights into your condition.

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