OpenHealth Q&A

Understanding My Symptoms: Tachycardia and Palpitations

I am a 31-year-old male living with Brugada syndrome, having previously experienced PSVT, which was addressed nearly a decade ago without any signs of recurrence. My medication regimen includes Xanax. It's important to note that within the context of Brugada syndrome, medical professionals often classify it as a relatively mild condition—specifically in cases where only drug-induced type-1 Brugada ECG is present without syncope. Consequently, my situation has been monitored since my diagnosis in mid-2015, and I have undergone nearly ten years of observation without the implementation of an implantable cardioverter-defibrillator (ICD). I have been reflecting on symptoms that may stem from not just my heart condition but also a long-standing struggle with panic attacks. I previously experienced panic-related cardiac symptoms, which over time turned into more unusual manifestations. The onset of these symptoms wasn’t abrupt; rather, it was a gradual evolution over the past decade. Specifically, I began to notice a shift: previously, whenever I encountered psychological disturbances, such as moments of anger, my heart rate would increase, but it would return to baseline once I calmed down. This reaction is typical for most individuals. However, recently, even after regaining my mental composure, my heart rate remains elevated, hitting levels of around 120 to 130 bpm, which is quite alarming. This persistent tachycardia feels unsettling and seems to occur particularly when my autonomic nervous system is more intensely stimulated. During these episodes, I find relief only after taking a tranquilizer, which helps stabilize my heart rate. Although I mentally feel balanced, my heart remains in turmoil, racing until I medicate. In earlier years, a small amount of anxiety would manifest as a rapid heartbeat. For a period, I was convinced that I was experiencing a return of PSVT, but Holter monitoring indicated it was merely sinus tachycardia. Now, after years of dealing with anxiety-driven cardiac symptoms, these recent developments have escalated. The strangeness of these symptoms prompts me to seek clarity. I cannot find anything online that accurately describes what I am experiencing. Might my panic disorder or an imbalance in my autonomic nervous system have worsened, particularly affecting my heart? Additionally, I grapple with another issue—palpitations. Interestingly, these experiences often occur without accompanying tachycardia, yet they can be quite frightening. Similar to my other symptoms, I suspect these palpitations may be linked to my chronic panic disorder. For instance, I notice persistent palpitations triggered by even minor stimuli that provoke my autonomic nervous system, such as physical exertion or stressful visual stimuli. During such episodes, my heart rate remains within the normal range (60-100 bpm), yet the sensation of palpitations is present, often accompanied by a sense of anxiety. At times, even serious overthinking can lead to these palpitations, which happen frequently and can be triggered by trivial matters. On these occasions, while my heart rate may be normal, the palpitations or discomfort in my chest persist. Moreover, palpitations aren't solely characterized by a noticeable heartbeat in my chest; there are times I can feel my blood vessels pulsing strongly. While sitting or lying down, I can sometimes feel my body move in sync with the rhythm of my pulse. Last June, the intensity of my palpitations peaked, coinciding with the trauma of witnessing a heart attack close-up. The psychological aftermath of that event significantly impacted my mental state and, subsequently, my heart's performance. My pulse remained below 100, yet I felt an overwhelming pounding sensation. The throbbing in the blood vessels in my neck was so pronounced that I could observe it in the mirror. When researching palpitations, I often encounter information correlating them with tachycardia, bradycardia, or arrhythmias. However, I experience palpitations even when my heart rate is normal, which complicates the situation further. Last year, I underwent numerous heart evaluations, yet no additional heart conditions were diagnosed. Given my age, I doubt that significant heart disease could develop within such a short period, particularly since my symptoms have existed for quite some time and seem to have intensified alongside my ongoing panic disorder. However, the oddity and distress of what I’m experiencing compel me to ask: what exactly are these symptoms?

Answers (1)

3/18/2025, 4:01:13 AM

OpenHealth AI

It's understandable to feel concerned about your symptoms, especially given your history with Brugada syndrome and panic disorder. You're experiencing a complex interplay between your cardiac symptoms and anxiety-related responses, which can be quite distressing. Let’s break down your situation and explore it further.

Summary of Key Points:

1. Symptoms Overview: Persistent tachycardia (heart rates of 120-130 bpm) and palpitations occur, often linked to psychological triggers.
2. Context of Conditions: Brugada syndrome, managed without an ICD, alongside a long-standing history of panic attacks.
3. Impact of Anxiety: Anxiety appears to exacerbate both your heart rate and the sensation of palpitations, even when your heart rate is normal.

Explanation:

Your persistent tachycardia after calming down from triggers could indeed be influenced by your autonomic nervous system, which controls heart rate among other functions. In moments of anxiety or panic, your body's "fight or flight" response can keep your heart racing even after the initial trigger has passed. This prolonged elevated heart rate may reflect heightened anxiety rather than a direct heart condition, especially in light of your previous evaluations showing no additional heart issues.

Palpitations, which you experience separately from tachycardia, can arise from anxiety as well. The sensation of your heart pounding, or even feeling your blood vessels pulse, can be a physical manifestation of heightened sympathetic nervous system activity. It's common for individuals with anxiety to experience such symptoms, regardless of whether their heart rate fulfills criteria for tachycardia.

Actionable Next Steps:

1. Mindfulness and Relaxation Techniques: Implement daily practices such as deep breathing, meditation, or progressive muscle relaxation to help manage anxiety and its physical manifestations. These practices can help stabilize your autonomic function over time.

2. Monitoring Triggers: Keep a journal detailing your episodes of tachycardia and palpitations. Note any potential triggers and how your symptoms evolve. This information can help identify patterns and may provide insight that could be useful in future evaluations with healthcare professionals.

3. Gradual Exposure to Anxiety Triggers: If possible, consider gradually exposing yourself to the environments or stimuli that provoke anxiety, with the goal of helping your body adapt and develop resilience while incorporating relaxation strategies beforehand.

4. Routine Evaluations and Discussions: Schedule regular follow-ups with your cardiologist or a mental health professional. Open dialogues about the interplay of your panic disorder and heart symptoms can lead to more effective management strategies. Discussing your experiences openly may also validate your feelings and provide relief.

5. Evaluate Medication Impact: Since you are using Xanax, consider discussing with your healthcare provider whether adjustments or alternatives could help control anxiety while minimizing cardiac effects.

6. Lifestyle Considerations: Maintain a balanced diet, regular exercise (as tolerated), and ensure adequate rest since these factors can significantly influence both anxiety and heart health.

Reassurance:

It’s important to remember that you are taking a proactive approach by reaching out to understand your symptoms better, and findings from prior evaluations are reassuring. Remaining observant and engaged with both your mental and physical health can lead you towards feeling more at ease.