Heart Palpitations: Causes and Management Strategies

When the heart rate increases, it may pause momentarily?

Hello, Doctor.
Since the first time I experienced a brief pause in my heartbeat, I started taking three doses of antiarrhythmic medication daily.
After starting the medication, I haven't had any more episodes of the pause.
The doctor then reduced my dosage to two pills, and after taking them for a while, I still haven't experienced any pauses in my heartbeat.
However, in the past few days, I've noticed that whenever I transition from a resting state (for example, sitting with a heart rate of 70 beats per minute) to walking (with a heart rate of 80 to 90 beats per minute), I feel my heartbeat pause again.
This morning, I walked about two to three hundred meters from my home to the bus stop and counted approximately ten instances of this pause.
Once I sat down on the bus, my heart rate returned to around 70, and I didn't experience any pauses for about half an hour.
However, when I got off the bus and started walking again, the pauses returned.

Could you please explain what might be causing this? I am currently taking antihypertensive medication, and when I measure my blood pressure at home, it is around 120-130/70-80.
However, when I visited the doctor yesterday, my blood pressure was measured at 158/98.
Could this be related to my anxiety when seeing the doctor? Might this anxiety be causing the pauses in my heartbeat?
Additionally, I would like to ask if autonomic nervous system dysfunction could lead to symptoms like mine.
I looked up the symptoms of autonomic nervous system dysfunction online, and it seems I have many of them.
I suspect that my long-term poor sleep at night might be a contributing factor.
How should I go about getting this checked? When I asked the cardiologist yesterday if I might have autonomic nervous system dysfunction, he simply said that my situation is not that straightforward, so it wouldn't be autonomic dysfunction, and I didn't ask further.

Thank you for your response!

Yíhuò de rén, 30~39 year old female. Ask Date: 2010/08/18

Dr. Bu Shiyun reply Cardiology

Occasional pauses in heartbeat are often benign premature contractions (or early beats) and usually do not require much concern.
Many people experience elevated blood pressure at the hospital due to anxiety, so it is advisable to rely on blood pressure measurements taken at home.
Autonomic nervous system dysregulation typically refers to multiple physical and mental discomforts caused by prolonged stress, emotional imbalance, and poor sleep, rather than an actual neurological issue.
It is recommended to consult a psychosomatic medicine specialist.

Reply Date: 2010/08/18

More Info

Heart palpitations can be a concerning symptom, and understanding their causes and management strategies is essential for effective treatment. Based on your description, it seems you have experienced episodes of your heart feeling like it "pauses" or skips a beat, particularly during physical activity. This can be distressing, especially when combined with fluctuations in your blood pressure readings and feelings of anxiety.

Causes of Heart Palpitations
1. Physiological Factors: Palpitations can occur due to normal physiological responses, such as increased heart rate during physical activity. When you transition from rest to activity, your heart rate naturally increases to meet the body's demand for oxygen. However, if you experience a sensation of skipping beats or pauses, it may indicate an underlying issue.

2. Medication Effects: You mentioned taking antiarrhythmic medication (脈序律) and antihypertensive drugs. These medications can sometimes cause side effects, including palpitations or changes in heart rhythm. It's important to discuss any new symptoms with your healthcare provider, as they may need to adjust your medication.

3. Anxiety and Stress: Your blood pressure readings suggest that you may experience anxiety, particularly in clinical settings. Anxiety can lead to increased heart rate and palpitations. The "fight or flight" response can cause your heart to beat faster or feel irregular, especially when you are under stress.

4. Autonomic Nervous System Imbalance: You mentioned concerns about autonomic nervous system (ANS) dysregulation. The ANS controls involuntary bodily functions, including heart rate. Stress, poor sleep, and other lifestyle factors can lead to dysregulation, potentially causing palpitations. Symptoms of ANS dysregulation can include irregular heartbeats, anxiety, and fatigue.

5. Underlying Cardiac Conditions: While your heart function appears to be preserved based on previous tests, it’s essential to rule out any structural heart issues or arrhythmias that could contribute to your symptoms.

Management Strategies
1. Monitoring and Documentation: Keep a detailed diary of your symptoms, including when they occur, their duration, and any associated activities (e.g., walking, stress). This information can help your healthcare provider identify patterns and potential triggers.

2. Medication Review: Consult your physician regarding your current medications. If you are experiencing side effects, they may consider adjusting your dosage or switching to a different medication.

3. Lifestyle Modifications: Focus on maintaining a healthy lifestyle, including regular exercise, a balanced diet, and adequate sleep. Reducing caffeine and alcohol intake can also help minimize palpitations.

4. Stress Management Techniques: Incorporate relaxation techniques such as deep breathing exercises, meditation, or yoga into your daily routine. These practices can help manage anxiety and improve overall heart health.

5. Regular Follow-ups: Continue to have regular check-ups with your cardiologist. If your symptoms persist or worsen, further investigations, such as an echocardiogram or Holter monitor, may be warranted to assess your heart's rhythm over a more extended period.

6. Consider Psychological Support: If anxiety is a significant factor in your symptoms, consider speaking with a mental health professional. Cognitive-behavioral therapy (CBT) can be effective in managing anxiety and its physical manifestations.

Conclusion
In summary, while your symptoms of palpitations can be distressing, they may be influenced by a combination of physiological, psychological, and medication-related factors. It is crucial to maintain open communication with your healthcare provider to explore these aspects further and develop a comprehensive management plan tailored to your needs. Regular monitoring, lifestyle adjustments, and stress management techniques can significantly improve your quality of life and help alleviate your symptoms.

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