Palpitations: Are They Heart-Related or Anxiety-Induced?

Palpitations with a rapid heartbeat?

Hello, about a week ago, I suddenly started feeling chest tightness while sitting, needing to take deep breaths intermittently.
After a day or two, the frequency of feeling unable to breathe increased, and I began to notice an unusual sensation in my heartbeat.
Although my heart rate was normal, the beating felt very pronounced and uncomfortable, making it difficult to sleep at night (and surprisingly, I didn't feel tired).
The next day, I quickly made an appointment with my family doctor, who performed an electrocardiogram (ECG) and X-ray (during which my heart was also uncomfortable).
The doctor reviewed the results and said there were no issues, even stating that the ECG report was very good, and suggested I observe for a few more days, mentioning that it could be psychologically induced anxiety (I had informed the doctor that I had been busier lately and my sitting habits were irregular).
However, now it has been almost a week, and despite adjusting my routine and trying to rest as much as possible, my condition remains the same, especially feeling worse when lying down.
In the past two days, I have also felt stiffness in my neck, and I experienced insomnia last night, which is quite distressing.

Since childhood, I have had heart issues; after intense exercise, I sometimes struggle to catch my breath, and my heart would suddenly race as if it were losing power, lasting from several minutes to a few hours (a few times over several days).
My neck would also feel stiff, and there are moments of shortness of breath, often triggered suddenly by coughing or squatting (in a low position), accompanied by a sensation of blood rushing to my head, as if my heart were being squeezed, after which my heartbeat would return to normal.
I have previously undergone ECG and blood tests for this reason, all of which were normal.

Currently, the sensation of my heartbeat feels similar to those past experiences.
I recall that after doing routine aerobic exercises, my heartbeat and breathing would return to normal.
I have tried leaning forward or squatting down, but it hasn't helped; I still experience a sensation of blood rushing, with my heartbeat normalizing for a few seconds before becoming uncomfortable again.
The sensation of pressure extends from the back of my head to the top of my head.
Since last night, my heartbeat has been intermittently slowing down, feeling more like usual, accompanied by a sensation of blood rushing to my head, but after a few seconds, it becomes noticeably rapid again.
I have taken the medication prescribed by the doctor, Inderal, but I feel no improvement; instead, my heartbeat seems more irregular.

Could this be a heart-related issue, or is it truly caused by anxiety? Thank you.

hsuan, 20~29 year old female. Ask Date: 2012/05/07

Dr. He Dongjin reply Cardiology

Hello, your symptoms are clearly caused by autonomic nervous system dysfunction, which may be triggered by recent stress or changes in climate.
Please try to relax.
I have attached a list of common symptoms of autonomic nervous system dysfunction for your reference.
I would also like to recommend a book that may provide you with some help.
Changhua Hospital cares about you.

Reply Date: 2012/05/07

More Info

It sounds like you are experiencing a complex interplay of physical and psychological symptoms that can be quite distressing. Your description of palpitations, chest tightness, and difficulty breathing, especially when lying down, suggests that you are dealing with significant anxiety, which can manifest in physical symptoms. However, it is essential to consider both the psychological and physiological aspects of your condition.

Firstly, it is reassuring to hear that your recent medical evaluations, including an electrocardiogram (ECG) and chest X-ray, have returned normal results. This is a positive sign that your heart is functioning well from a structural and electrical standpoint. However, the persistent sensations of palpitations and discomfort you are experiencing can still be quite uncomfortable and concerning.

Palpitations are often associated with anxiety and stress. When you are under pressure or feeling anxious, your body enters a "fight or flight" mode, which can lead to increased heart rate and a heightened awareness of your heartbeat. This can create a feedback loop where the more you notice your heart racing, the more anxious you become, which in turn can exacerbate the palpitations. This phenomenon is commonly seen in individuals who have anxiety disorders, and it can be particularly pronounced during periods of heightened stress or change in routine.

You mentioned that you have a history of heart issues, which may contribute to your heightened sensitivity to bodily sensations. It is not uncommon for individuals with a history of cardiac concerns to become more aware of their heart's rhythm and function, leading to increased anxiety when they perceive something unusual. The feelings of tightness in your neck and the sensation of blood rushing to your head may also be related to muscle tension and anxiety, which can cause physical discomfort and exacerbate feelings of panic.

Given that your symptoms have persisted despite adjusting your routine and taking medication (inderal), it may be beneficial to explore additional therapeutic options. Cognitive-behavioral therapy (CBT) is a highly effective treatment for anxiety and panic disorders. It can help you identify and challenge the thought patterns that contribute to your anxiety and teach you coping strategies to manage your symptoms more effectively.

Additionally, practicing relaxation techniques such as deep breathing exercises, mindfulness meditation, or progressive muscle relaxation can help reduce anxiety and improve your overall sense of well-being. These techniques can be particularly useful when you feel the onset of palpitations or anxiety, as they can help calm your nervous system and reduce the physical sensations you are experiencing.

It is also important to maintain open communication with your healthcare provider about your symptoms and any changes you notice. If you feel that the medication is not helping or is causing additional discomfort, discussing alternative options or adjustments with your doctor is crucial. They may consider other medications or therapies that could be more effective for your specific situation.

In summary, while your symptoms may be rooted in anxiety rather than a direct heart problem, it is essential to address both the psychological and physical aspects of your experience. Seeking therapy, practicing relaxation techniques, and maintaining a dialogue with your healthcare provider can help you navigate this challenging time and improve your overall quality of life. Remember, you are not alone in this, and there are effective strategies and support available to help you manage your symptoms.

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