Can Fibromyalgia Cause Heart Palpitations?

In this article, we will take a close look at the potential link between fibromyalgia and heart palpitations. Fibromyalgia affects individuals three to eight percent of people across the globe, making it quite common. Despite its prevalence, there is still a lot of unknown about this disease. We will discuss the impact of fibromyalgia on heart function and autonomic nervous system activity.
Jakub Gwiazdecki

Jakub Gwiazdecki

Fifth year medical student at the Medical Faculty of Comenius University in Bratislava.

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Can fibromyalgia cause heart palpitations?

Yes, fibromyalgia (FMA) can cause heart palpitations. However, it is not considered to be the direct cause of heart palpitations. Fibromyalgia is associated with changes in the autonomic nervous system. Following the alternations in the nervous system, changes in heart function can occur. These changes in the heart’s activity can be experienced as heart palpitations.

Patients with FMA can have lower 24-hour heart rate variability (24-HRV). This measurement allows us to assess the time between the heartbeats and is an indicator of how the heart is adapting to different situations. A decline in the 24-HRV shows that the heart is not responding well to different changes during the day. Such a condition is a bad prognosis for the heart [1].

Similarly, patients with FMA had a higher baseline heart rate as well as during the cold pressure test [2]. This could potentially contribute to feelings of palpitations.

However, while fibromyalgia patients may report palpitations, there is no difference in the risk of arrhythmias between fibromyalgia patients and healthy individuals [3, 4].

What is fibromyalgia?

Fibromyalgia is a chronic syndrome of widespread musculoskeletal pain. The pain is often accompanied by fatigue, nonrestorative sleep, mood disorders, and cognitive dysfunction, often referred to as "fibro fog" [3, 5]. The American College of Rheumatology defines fibromyalgia as widespread pain with 11 of 18 tender points [6, 7, 8]. The prevalence of this disease shows it is a common condition. It affects approximately two to eight percent of the global population, especially women [9, 10].

Fibromyalgia is also associated with a variety of other physical and mental symptoms. The presentation can range from stiffness, depression, anxiety, and headaches to digestive problems [11]. It can coexist with other inflammatory rheumatic diseases such as rheumatoid arthritis, systemic lupus erythematosus, or osteoarthritis. The phenomenon of accompanying other diseases is known as secondary fibromyalgia [11].

The exact etiology of fibromyalgia is unknown. It is believed to involve genetic, psychological, as well as environmental factors. It is not considered an autoimmune disease. However, in some cases, it can become an early sign of an autoimmune disease [11].

How does fibromyalgia impact the heart?

The ways in which fibromyalgia influences the heart include structural changes, function, and electrophysiological alternations.

Upon ECG examination, patients with fibromyalgia have been found to have changes in their electrical signals. The recorded waves were dispersed, and the fragmented QRS complex was more often visible than in healthy individuals. Such conditions in the electric propagation circuits of the heart can increase the risk of arrhythmia in the affected patients [12].

Fibromyalgia can also affect the heart's diastolic function. The isovolumetric relaxation time and mitral E-wave deceleration time are longer compared to non-affected individuals. Those markers are indicators of the diastolic function of the heart. An increase in their values suggests that fibromyalgia patients may be at risk of impaired diastolic function of the left ventricle [13]. The development of this dysfunction over time can lead to heart failure.

In addition, fibromyalgia patients have been found to have a higher risk of developing coronary heart disease (CHD). This was drawn from the increased incidence of CHD in this patient [14].

Furthermore, fibromyalgia can influence the cardiac conduction system. Signs of atrial remodeling on ECG were found in patients (longer P-wave dispersions). The changed structure of the upper chambers of the heart increases the risk of atrial fibrillation [15].

Fibromyalgia can also affect autonomic cardiovascular regulation. Especially fibromyalgia patients with depression were found to be less responsive to blood pressure changes. Additionally, their hearts showed smaller adaptations to the needs of the different situations encountered during the day [16].

What is the treatment for fibromyalgia?

Fibromyalgia is a complex chronic pain disorder that influences the quality of life of those affected. The treatment consists of a comprehensive approach that includes both pharmaceutical and non-pharmacological therapies [17].

Pharmacological treatments include pain modulation medication. Drugs that were approved for this purpose by the Food and Drug Administration (FDA) include duloxetine, milnacipran, and pregabalin. Some medications used are considered off-label, like amitriptyline, cyclobenzaprine, gabapentin, or naltrexone [18]. In mild to moderate cases of pain, over-the-counter pain relievers such as acetaminophen (tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) can be used [19].

However, for the first line of treatment, non-pharmacological treatments are recommended. These include aerobic exercise and cognitive-behavioral therapy. Especially the first one, which is very effective. Additional approaches such as digital health interventions, combined treatments, as well as non-invasive neuromodulation [18].

An integral part of the treatment is lifestyle changes. They aim to improve the patient's overall well-being. These include improvements in sleep quality, regular physical activity, stress management, and a healthy diet [20].

One of the most commonly used methods for pain management is cognitive-behavioral therapy (CBT). During the CBT sessions, the patient can identify and challenge their negative thoughts about the disease and themselves. The process aims to learn how to cope with the pain and physiologically tries to improve the patient's quality of life, also by setting goals [21].

As a complementary therapy to help with the symptoms, massage therapy, movement therapy, chiropractic therapy, and acupuncture can be implemented [20].

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Jakub Gwiazdecki

Jakub Gwiazdecki

Jakub is in his fifth year as a medical student at Comenius University in Bratislava, Slovakia. He has special interested in cardiology and in patient-centered medicine. His love for heart health isn't just book-smarts; he wants to know how it works, what it means for our feelings, and how key it is for health and happiness. Jakub thinks real good health care comes from always putting the patient at the centre, treating each person as a whole.