Hiatial Hernia § Heart PVC's.

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I'm a 33 year old (overweight) male.  About 4 months ago, after having pain in my upper abdomen, I was diagnosed with a Hiatial Hernia.  I had known I had "something" for a while, because there was a spot just below the breat bone that I could press and feel a "pop".  Regardless, I was given Pepcid 40mg to take once a night, but I didnt because I didnt think I needed it (yes, Im stubborn).  However, during the last few weeks, I've noticed more problems with the Hernia, and especially the last few days.  I've noticed a feeling like food is backing up into my espophagus, and from time to time when that happens, I'll feel my heart "flip" over itself.  I normally just press on the hernia and feel the "pop" and everything is fine.  However, last night, my heart started doing the "flips" (abnormal heart beats" and would not stop.  This scared me so my mom immediately drove me to the ER.  But by the time I got there, and hooked to the EKG, I had laid down and everything stopped. The EKG was perfectly normal, and everything showed as fine. I've been prone to Panic Attacks in the past, so the physician wrote it off as being an Panic Attack.  Today, I felt fine, and only ate Beef Stew which I cooked myself about 3pm.  Around 6pm, I was doing some light activity in the house, and I felt another "flip", which I ignored.  A minute later, I felt another, then another, and it started again.  I AGAIN went to the ER immediately, and they hooked me to the EKG.  This time, they saw what I was feeling... PVC's.   I described to them, that it felt like something stuck in the esophagus, and that if I burped it felt better.  In fact, I almost threw up when I get to the ER but couldnt get it up far enough.  The DR wrote these symptoms off as being nothing and that the hiatial hernia could NOT be the cause.  He did blood work and determined that my Magnesium and Potassium levels were on the very low end of the NORMAL range, so he told me to take some supplements and he felt everything would be fine.  By this time, I was relaxed and the EKG was again normal, so they sent me home.  I came home, took some vitamin supplements with Magnesium and Potassium, but about 10 minutes later the PVC's started again, with the vitamins feeling stuck in the upper part of my esophagus.  When I lie back in the recliner and relax, the PVC's subside, but not without scareing me to no end.  I've been reading a lot on here about Hiatial Hernia's and Reflux being associated with Heart PVC's, and there seems to be a big disagreement among physicians regarding this.  However, after reading many letters in the forum that describe the same thing that's happening to me, I'm convinced there is a connection between the PVC's and my gastro problems.
What would you suggest?  I just took one of my 40mg Pepcid, and it seems to be going down, but I can still feel the "lump in my throat" as if there's still food or vitamins stuck there.
Any advice you could give would be greatly appreciated!  Thank You!!!

[Kevin Pho, MD]

Hello - thanks for asking your question.

It is possible that the discomfort from the hiatal hernia is responsible for the PVC's.  

At minimum, you need a thorough workup for your palpitations before attributing it to panic attacks.  EKG, potassium and magnesium are not enough.  

I would suggest a holter monitor or event monitor.  Whenever you have these episodes of PVC's, you can press a button and it will record the EKG at the time of the symptoms.  If necessary, based on the results, you may be referred to an arrhythmia center for possible electrophysiology tests.  You can obtain these tests from your primary care physician.  

Tests for your thyroid function are also mandatory.  I would also suggest an echocardiogram (ultrasound of the heart) to make sure there is no anatomical abnormality that is causing your symptoms.  

Regarding your GI symptoms, I would consider more aggressive medical therapy such as PPIs (i.e. Nexium, Protonix etc.).  If you continue to have symptoms despite more aggressive therapy, then surgical options to repair the hernia should be considered.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[tessa0825]

Hi.....I hope you dont mind if I share with you some things that I have experienced with my Hiatal hernia...First, if I were you I would see your PCP and try to get a referral to a heart Dr....Anytime you have cardiac symptoms they need checked out before you can assume they are related to something else....I havent heard one Dr. make a definite connection between GERD and irregular heartbeats but this has been my experience with it.....several yrs ago I started waking up within the first hour after going to sleep (mine never varied from that) with my heart pounding...It felt like I had been running a race....On three occasions I went to ER and they found nothing...I started to think I was nuts.....Then some situations came up that landed me in the GI Spec. office and having EGDs....Thats when I found out I had  a lg hiatal hernia, ulcers, erosions, strictures, and barrett's esophagus...I started nexium 60mg a day, the rapid heartbeats went away....Over the last yr my reflux has had some setbacks and when it gets bad the rapid beats always start up again....Sometimes that is the first symptoms that I have that lets me know something is wrong in my esophagus. I have recently had my nexium increased to 100mg per day and along with the reflux settling back down so have the rapid heartbeats....It seems obvious to me that there is a connection but I also think it should never be assumed....My Father had been diagnosed with a hiatal hernia yrs ago, at times he would have terrible chest pains....we would take him to ER and as soon as they knew he had the hernia they didnt even look for anything else....They would tell him to take an extra Tagamet and you'll feel better tomorrow....I walked in my folks house one afternoon and looked out the kitchen window and saw my Dad laying in the middle of their back yard with Mother trying to get him up..I called 911, and even then, at the ER we were told "we know its that hernia hes got, but.....We'll observe him overnite and you can take him home in the morning".  Well, overnight Dad suffered a heart attacke so severe, that the clot that hit his heart, destroyed the bottom half of his right ventricle....He was life-flighted to Good Samaritan Hosp. in Dayton Ohio where he had a catherization the next day. We were told that he had suffered many heart attacks in the past and that he also had severe angina...That info came to late to help him....Dads heart ruptured the next nite...we allowed an autopsy to be done that confirmed that as the cause of death, as having your heart rupture is very rare.....So, from my viewpoint, I dont think EKGs are conclusive to rule out all heart problems.....Stress test, echocardiagram, event recorders are all helpful with diagnosis......Best of luck.....Tessa

[tessa0825]

I forgot to add...You need to be consistent with taking your PPIs (previcid)!!! Acid-reflux disease can lead to very serious complications, if you dont get and keep it under control.....Tessa

[Feef]

I have acid reflux and hiatial hernia get these attacks where I can not digest my food..and spit it up 12  hours after I've eaten just like I had just swallowed it.And when I go to bed I wake up with my upper stomach just under my breasts throbbing and then both of my hands tingle.....And the next day feel weak and woozy...Once I get these attacks they last quite a while..Has anyone ever had these symptoms?????I would really appreciate any help I can get.I have had a stress test and heart work-up so that is not what it is..And just before this attack I felt like my heart was pounding , just for  about 30 seconds and all the other symptoms appear....thankyou soo much..Feef

[kcjmc]

For the past 6 months or so, I have experienced major bloating in my upper stomach, especially when I am stressed, even mildly about things. This has been followed by the heart flip flops described above. Before this time, I was put on 60mg Prevacid/day, which helps the reflux at night that I was having, but since then, the bloating started, along with the heart flips. I have had EKG's, a Holter monitor, chest xrays, and seen a heart specialist. What I learned was that I do have non-life threatening PVC's and POV's. Only thing is, they only seem to come on when I first feel the bloating, and I tend to feel the bloating when I have even mild stress. In addition to the bloating, I feel muscle pain in my shoulders/neck area, and a sense of fatigue in my shoulders and arms. I've been told after all the tests, including a chemical stress test, that my heart is fine and strong, other than the PVC's. My breathing is fine. I take a baby aspirin, .1mg synthroid in the morning, and 30mg Prevacid twice a day. I also seem to have IBS so I take a fiber supplement at night. Still, I get the bloating and heart flips, soreness in shoulders, and a sense of muscle fatigue. It slows me down in life. I am a 53 year old female, 5'3", 225 lbs. I cannot stay on a weight loss plan successfully, and have maintained this weight for at least 10 years. My life, including general health, marriage, career and finances is outstanding, and I'd really like to get to the bottom of what is happening to me. Am I depressed? What should I ask for or say to my PCP when I see her soon. Do I need to see a gastroenterologist? Help! Thanks.