Shortness of Breath and Fatigue: Heart or Autonomic Nervous System Issues?

Experiencing shortness of breath and generalized weakness?

Hello Doctor,
Around 2005, I underwent a comprehensive health check-up, during which an echocardiogram revealed mitral valve prolapse with mild regurgitation and trivial tricuspid regurgitation with blood flow reversal.
Later, I visited a psychiatrist due to physical discomfort and was diagnosed with neurosis, for which I have been on medication ever since.
I have been using autonomic nervous system medications due to persistent anxiety.

In November of last year, I experienced gastrointestinal discomfort and underwent endoscopy, X-rays, and blood tests.
Because I had lost weight, the doctor conducted cancer blood tests.
Aside from a gastric ulcer and Helicobacter pylori, all other tests were normal.
I have taken antibiotics and medications for the gastric ulcer, and in April of this year, I returned to the hospital for a breath test, where the doctor confirmed that the Helicobacter pylori was no longer present.

Recently, I have been feeling very short of breath, with almost no strength throughout my body.
My feet often feel numb, and I become breathless just climbing from the first to the third floor.
However, since my daughter is studying nursing and has a stethoscope at home, I listened to my heart and did not hear any abnormal sounds; it seemed to be beating normally.
Yet, I feel that my heart is racing, and I have been experiencing chest tightness for a long time.
Lately, I have been feeling very breathless, as if I can't catch my breath.

Doctor, could you please advise whether this is a heart issue or a problem related to the autonomic nervous system? Thank you, Doctor.

Zhang Nini, 30~39 year old female. Ask Date: 2015/06/28

Dr. He Dongjin reply Cardiology

Hello, it still seems to be a problem caused by the autonomic nervous system! I recommend continuing your treatment with your original physician at Changhua Hospital, who will take care of you.

Reply Date: 2015/06/28

More Info

Based on the information provided, it appears that you are experiencing significant symptoms including shortness of breath, fatigue, and a sensation of rapid heartbeats, which have raised concerns about whether these issues are related to your heart or are manifestations of autonomic nervous system dysfunction.
First, let's address the heart-related concerns. Your previous echocardiogram indicated mitral valve prolapse with mild regurgitation and tricuspid regurgitation, which can sometimes contribute to symptoms like palpitations or a feeling of breathlessness, especially during physical exertion. However, the echocardiogram results you shared later showed normal left and right ventricular function, normal wall motion, and no significant valvular lesions. This suggests that your heart's pumping ability is intact, and there are no major structural issues that would typically cause severe symptoms.
The Holter monitor results also indicated that while you experienced some premature atrial contractions (PACs) and a few premature ventricular contractions (PVCs), these are generally benign in the absence of other significant heart disease. The average heart rate was within normal limits, and there were no alarming arrhythmias detected. Therefore, while your heart may be reacting to stress or anxiety, the data does not suggest a severe underlying cardiac condition.

On the other hand, your symptoms could very well be linked to autonomic nervous system dysregulation, particularly given your history of anxiety and panic disorders. The autonomic nervous system controls involuntary bodily functions, including heart rate and respiratory rate. When someone experiences anxiety or panic, the sympathetic nervous system can become overactive, leading to symptoms such as rapid heart rate, shortness of breath, and feelings of fatigue. This can create a cycle where anxiety exacerbates physical symptoms, which in turn increases anxiety.

Your description of feeling fatigued, experiencing shortness of breath with minimal exertion, and having episodes of rapid heartbeats aligns with both anxiety-related symptoms and potential deconditioning due to reduced physical activity. It is also worth noting that anxiety can lead to hyperventilation, which can cause feelings of breathlessness and lightheadedness.

Given your recent gastrointestinal issues and the treatment for Helicobacter pylori, it’s also important to consider that chronic stress and anxiety can impact digestion and overall energy levels, potentially leading to feelings of fatigue and malaise.

In terms of management, it would be beneficial to focus on both physical and mental health strategies. Regular, gentle exercise can help improve cardiovascular fitness and reduce anxiety. Techniques such as deep breathing exercises, mindfulness, and cognitive behavioral therapy (CBT) can also be effective in managing anxiety symptoms. If you haven't already, discussing your symptoms with both your cardiologist and a mental health professional could provide a comprehensive approach to your care.

In conclusion, while your heart appears to be functioning well based on the tests, your symptoms may be more closely related to anxiety and autonomic dysfunction. It is crucial to continue monitoring your symptoms and to seek further evaluation if they persist or worsen. Regular follow-ups with your healthcare providers will ensure that both your physical and mental health needs are addressed appropriately.

Similar Q&A

Understanding Fatigue and Breathing Issues: When to Seek Heart Care

Hello, doctor. Over a year ago, I experienced a period of shortness of breath. Although I was breathing, I felt like I wasn't getting enough air. I later thought it might be due to drinking too much coffee (I was consuming about three cups a day for work). After that, it imp...

Dr. He Dongjin reply Cardiology
Dear Sir, Most of your described symptoms are caused by autonomic nervous system dysfunction. Another part, such as the deterioration of cardiopulmonary function and the sensation of chest tightness, should first rule out angina. I would like to know if you smoke. If your cardi...

Short Walks Leave Me Breathless: Understanding Symptoms and Solutions

Hello doctor, recently whenever I walk a bit further (slowly for about 30 minutes or more), I experience an increased heart rate, a feeling of shortness of breath, and my legs feel weak and fatigued. I also feel heavy-headed and tingly, and I have little energy to speak. I have a...

Dr. Jiang Junyi reply Neurology
Hello: Generally speaking, the autonomic nervous system is regulated by the sympathetic and parasympathetic nervous systems, with one acting as the accelerator and the other as the brake. The sympathetic nervous system is responsible for accelerating the heart rate, mobilizing en...

Understanding Arrhythmia and Autonomic Nervous System Disorders

Hello doctor, about 2-3 years ago, I started experiencing symptoms of chest tightness and palpitations, so I consulted a cardiologist. I underwent a 24-hour Holter monitor, an exercise stress test, and an echocardiogram, but no issues were identified. However, I have experienced ...

Dr. He Dongjin reply Cardiology
Hello, stress and lack of sleep can lead to autonomic nervous system dysfunction, which may cause arrhythmias; however, it is unrelated to left ventricular hypertrophy. Whether there is a correlation between arrhythmias and left ventricular hypertrophy should be discussed with yo...

Breathing Issues and Fatigue: Understanding Stress and Mental Health

Hello Dr. Tsai: I am currently a college student and have been working at an auto repair shop for a little over a month. Recently, I have started experiencing some difficulty breathing, and at times, I can feel my heartbeat more than before. I also occasionally feel short of brea...

Dr. Cai Yunlin reply Psychiatry
Hello, Xiao Zhong. The symptoms you described initially seem to be related to psychosomatic responses associated with stress or anxiety. Generally speaking, if these are temporary stress reactions, they should gradually alleviate over time with increased familiarity with work or ...