Rapid Heart Beat - spasms in lower right side

[WB1969]

I'm a 38 year old male.  About 3 months ago I thought I was having a heart attack... several heart tests were ran and I was told it was something else.  I went from 5'-7" 260 pounds to 220 pounds in this time by working out and a low fat diet.  This seemed to work for a while and then another episode 3 weeks ago.  This time my Doctor thinks that it is an anxiety attack. I really don't think that's what it is.  There is too much other stuff going on.
1) During the first "attack?" my heart started beating real fast and I came real close to passing out.  I was in a lying position at the time of the attack.  The similarities between the two episodes are that I had just eaten a big meal, it was in the evening and I had drank a lot of beer the night before.
The first time I also felt constipated and it felt like I was carrying my food real high in my stomach/lower chest.  Since then I had tightness in my chest and throat for a few weeks.  Also had increased heart rate at night which kept me from breathing right and kept me from sleeping as a result.
2) During the second attack I had the increase heart rate again and light headed.  This time I was in a sitting position and laughing real hard at a movie.  We called an ambulance and the oxygen settled me down.  I was given a xanax when I arrived at the hospital (my symptoms were pretty much gone by then anyways).  In a subsequent visit to my doctor I was given a 3 week prescription of lexapro and xanax for use as needed.  I still have trouble sleeping without some sort of sedative due to the increase heart rate when I lay down.  
I think that the episodes are physical, not mental.
I have acid reflux.  Constipation problems my whole life and recently at my heavier weight I had mucas in my stool, I don't have it now.  I have also in the last week felt hot flashes on my back and neck. Had muscle spasms in my lower right front side.  It seems to getting more frequent and usually stops when I get up and start walking.

[Kevin Pho, MD]

Difficult to say without evaluation.

If there is possibility of an arrhythmia, you can consider an event monitor or Holter monitor to document it.  An echocardiogram can be done to exclude structure heart disease.

Upper GI symptoms can be evaluated with an endoscopy, which would evaluate the stomach or esophagus.  More specialized tests can be done, such as a 24-hr pH study or gastric emptying scan to evaluate for GERD or gastroparesis respectively.  

These options can be discussed with your personal physician, or in conjunction with your personal physician.

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 patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com

[ebjb]

Your heart palpitations sound like Paroxysmal Atrial Fibrillation to me (which I have!)  My attacks of A F (for short) often come when I've just eaten a big meal and have had alcohol the day/night before. They also happen when I'm lying down. I have to take a sedative at night, but don't have so many attacks now I've been given Flecainide to take which is an anti-arrythmic drug. You should be given a heart monitor to wear for a few days so a diagnosis can be made as when A F is Paroxysmal it's difficult to diagnose as it can go as quickly as it came. Every time I went to my doctor or to the hospital my heart beat was fine. I had a monitor on for a week and it showed up then. Your other problems I doubt are related to your heart rate - you should have them checked out though - ask to be referred for tests - endoscopy for acid reflux and colonoscopy for bowel problems. I also have pain in my lower abdomen when I waken up each morning which stops when I get up and start walking. I've had bladder and kidney scans, abdomen X - ray and going for colonoscopy (AARGH!) on 14th Jan.  Hope this info helps - Good luck

[Kevin Pho, MD]

Sorry, the last statement should have read:

"These options can be discussed with your personal physician, or in conjunction with a cardiologist or gastroenterologist."

[hotwheels]

In rare cases reflux can cause heart palpitations. I know because I have bile reflux and have been suffering from heart palpitations for a while and my symptoms are almost identical to yours. I haven't been able to lie down for almost a year now and it is especially worse when I am on my left side. At the beginning it only happened once in a while now if I don't take medication my heart rate will go up to 180 and stay there for hours and this is every day.

It sounds like you feel that your heart palpiItations are linked with your reflux. In my case that's what I thought too but was told repeatadly that there was no link. It took me a long time to get the right diagnosis. Some doctors thought I had a P.A.T. (paroxsymal atrial tachycardia), some thought I was crazy. I was referred to a psychiatrist who recognized what was going on. The cardiologist I saw afterwards confirmed the diagnosis. There is nothing wrong with my heart and I was told I do not have an arrhythmia.
It is amazing how many doctors don't know about this!

If this is what you are suffering from the key is to get your reflux under control. Unfortunatly for me treatment for my bile reflux has not been a succsess that is why I am still sufferring from these palpitations. The palpitations can be treated with beta blockers or calcium channel blockers.

I hope this helped. I know what it's like when you know something is wrong with you and your doctor seems to think you are crazy. Good luck and I hope you can find a doctor who can help you.

[osusana]

Your symptoms aren't uncommon. I wish that I could remember the name of the forum but it had hundreds of posts that had GI problems causing arrhythmia's. Have you had any GI tests to rule out gall stones, biliary colic with the spasms, hiatal hernia, or ulcers? I would guess that your weight, diet, and ETOH consumption also has a lot to do with your symptoms. The laughing triggering the episode that you experienced could be a valsalva movement which could cause a short arrhythmia. Vagal nerve stimulation in the stomach can also cause cardiac symptoms. Having a hangover from drinking a lot of beer the night before can make you anxious and increase your heart rate even the next day, add any caffeinated beverages and your setting yourself up for your symptoms. I would suggest checking with your MD to get an event monitor, GI tests, and a sleep study. Loose weight, drink in moderation, cut the caffeine and take Zantac 150mg in the morning and an hour before bed for 6 weeks. Cut fats, especially fried foods from your diet and start an exercise program. Eat 6 smaller meals a day. Elevate the head of your bed on 6" blocks. Inderal 10-20 mg 4x day would help with the heart rate and anxiety both but would talk to your MD and cardiologist. As soon as you lose the weight, control the drinking and are on a healthy diet, you could talk to your MD about stopping the meds. I like Inderal better than the other beta blockers because it is not as specific as atenolol and works better for anxiety and panic attacks. If you smoke, I would recommend that you quit because nicotine is a stimulant as well and you want to eliminate as many stimulants as possible. Good luck, you can to it!
Sue