Re: Fatty liver/Gilbert's Syndrome

Posted By HFHS M.D.-dm on January 16, 1998 at 12:44:42:

In Reply to: Fatty liver/Gilbert's Syndrome posted by Peter Burton on January 09, 1998 at 17:37:00:







: Hello I have a peculiar problem that seems to be baffling the specialists.
About 4 years ago I noticed my heart rhythum was abnormal.  This
lasted for about 3 months and then went away.  At about the same time
my doctor noticed an abnormally high billirubin count and said I had
Gilbert's Syndrome but not to worry as it was a benign condition.
I am 36 (male) in other wise perfect health with no family history of
any cardiac or liver problem.  The arrhythmia went away for 2 years, during
which I was able to run about 30 miles a week, including a marathon run.
The arrhythmia returned for no apparent reason and once again lasted for about
3 months. By this time the cardiologists had done their tests and
said I had PSVT, nothing to worry about.  Again the arrhythmia went away but came
back a year later, and has basically stayed with me ever since.  
Last spring it actually went into afib for 12 hours before meds converted
it back to sinus rhythm.  So how does this connect with the liver you ask?
Well I have always noticed pressure and some bloating around my abdomen that
comes and goes.  An ultrasound recently showed that my liver is fatty. I was
told it had the appearance of an obese alcoholic.  Again I don't drink and I am
generally a muscular runner (no extra weight).  The final puzzling piece involves
the action of swallowing.  Every time (100%) I swallow the heart rhythm is broken.
It actually makes eating difficult at times.  The afib has occurred 3 times and in
each case I swallowed just before it occurred.  The electrophysiologists cannot explain
this and say they have never heard of such a connection.  My family doctor has me
booked for a barium swallow to look for esophagus/hiatus hernia problems.  I also
understand the vagus nerve follows the esophagus.  Can you account for the swallowing
as a trigger for heart arrhythmias?  Can some metabolic disorder affecting my liver
possibly be affecting my heart also (fatty infiltration of both tissues)?  Please advise
any possible leads as I am becoming quite exhausted searching remote corners of the internet
for any similar stories.  Sorry for the lengthy story but I wanted you to have all the facts.
*An EP study showed no accessory pathway.  Thankyou. Peter Burton




_____

Dear PB:

I enjoyed your story and can appreciate your frustration.  You ask several different interesting questions.  One question was whether the appearance of fatty liver on your ultrasound could be in anyway be associated your cardiac arrhythmia.  First it would be interesting to know all your liver associated enzymes to help make sure that you do have a benign liver condition.  The appearance of fatty liver on an ultrasound can be caused by a wide variety of things some as simple as having several drinks or a particularly fatty meal the day before.  You might even have a perfectly normal liver that just looked somewhat fatty on the ultrasound.  I do not know if your liver condition is related to your heart condition but your concern is reasonable. fatty liver is associated with high cholesterol and triglyceride levels in your blood which can also cause heart problems and you would probably want to have these levels checked.  There are other rare conditions that can cause infiltrates in both the liver and heart (amyloid, sarcoid, hemachromatosis) and these are usually easy to rule out.  

Your second concern is also very interesting.  You wonder if swallowing food can trigger your atrial fibrillation.  Like your cardiologists, I havent heard of a similar story.  You should remember that people swallow many times a minute and something may seem like its related to swallowing when its really a coincidence.  I do agree that the esophagus, the tube that connects your mouth and stomach travels behind the left atrium which is the part of the heart that fibrillates.  I suppose it is possible for a large bolus of food to irritate the left atrium as it passes through the esophagus.  I agree that a barium swallow might be interesting.

I think the most important thing is that you be evaluated by a good cardiologist to take care of your heart problems and a gastroenterologist to make sure everything is fine with your liver.  It sounds like youre already doing that.  If youre in Detroit and want to be seen by one of our liver specialists you are welcome to call [phone] which is the direct number to our Liver Clinic.

This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.  

I hope this information is helpful to you.


HFHS-dm
keywords: fatty liver, Gilberts, atrial fibrillation, steatohepatitis
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