A Fib and Hiatal Hernia/Digestive Problems

[annie]

I have recently been diagnosed with A Fib. I had an episode while at my doctor's office and it was recorded on the EKG. I've had a heart echo that was normal and my other EKGs are fine. The fibs tend to happen between 1 and 6pm during the day and they can last from 1 minute to 2 hours before going away on their own. I am taking Dilacor XR 180 and for 7 days now, Coumadin 5mg.

I have a hiatal hernia that was diagnosed several years ago and I take protonix for 3-4 weeks about 6 times/year for that.

I have noticed that my fibrillations always feel as though they're starting in my stomach. I get this odd, bubbly feeling in my stomach that seems to rise and within a few minutes, the fibrillations start. Is it possible that digestive/hernia problems can cause this? I've never had them before (I'm a 43 year old woman, and am overweight). Oddly enough, I was diagnosed with neuphratic syndrom (syndrome) about the same time I was diagnosed with the fibs (It's been a BAD month). The kidney problems resulted from over-use of NSAIDs and that seems to be abating somewhat.

The second thing I can't understand is that while the fibs can also seem to be triggered by my heart rate going faster than normal if I'm carrying groceries up a hill, they have not yet been triggered when I swim (freestyle for 20-30 minutes straight).

So the questions are. Can fibs be triggered by gas/hernia/digestive problems? Can they be related to kidney disease? and finally, why does walking set them off and swimming doesn't?

Thanks for your help. My cardiologist is HMO and not really that forthcoming with advice/help other than sticking me on Coumadin.

annie

[CCF CARDIO MD - DLB]

Most likely the afib is not related to gas or the hiatal hernia or digestive problems - these are just common occurrences and it may seem that one is trigering the other. Kidney disease can predispose to afib, but only if has caused severe electrolyte imbalances - this does not appear to be the case with you as best I can make out from the letter - blood work would pick this up anyway. The walking - swimming connection is probably also more coincidence than a real connection.

[JR]

Annie,
even though the docs. will tell you "no, thats impossible"....yes it does happen.

[Paul S]

I am pretty well convinced that acid reflux does at the least contribute to arrythmias!!

You should try to stay on Protonix and see if you still have problems. I assume you have problems when you are not on PPI's?

P

[JR]

SEE! I TOLD YOU HE'D SAY THAT!!!!

[Beate]

Dear Annie
In Germany Doctors call this a Roemheld-Syndrom.

Originally termed "Roemheld-Techlenburg-Ceconi-Syndrome", it is used to characterize a gastrocardiac symptom complex, first described by Ludwig Roemheld (1871-1938): In enteric disease, flatulence or bowel distention due to extensive gas production in the upper abdomen/colon transversum and left colon flexure leads to elevation of the diaphragm, and secondary displacement of the heart. This is complemented by gastro-coronary reflexes with "functional cardiovascular symptoms" similar to chest-pain on the left side and irradiation to the left shoulder, dyspnea, sweating, up to angina pectoris -like attacks with extrasystoles, drop of blood pressure, and tachycardia (high heart beat). Typically, there are no changes / abnormalities related in the EKG detected.

[Peter]

I was diagnosed with AFib five years ago. I am convinced it is started by digestive/gastro problems because I know my own body and can feel that build up from low down followed by pressure around the chest - particularly left side. AFib for me can last a few days and I can tell when its ending because there's a 'gurgling' in my chest as if a drain has been opened by the diaphragm - then everything's fine again. If I have a heavy or spicy meal in the evening and lie down it triggers immediately as if the food has come back up and pressured the heart.

[enoch]

Amen. Same here. No A-fib but instead the evil PVC"S and PAC"S. I asked my Doc and he said he had never heard of the connection. I am awaiting an e-mail reply from a friend whos said they had an article connecting heart palps of sorts after a large meal and related to a "stressful gastro". Hmmmmmmmmm Could WE be on to something that medical science is not?

[Rick]

I agree completely that a large meal can cause A fib.  I have had  several instances of A fib twice sending me to the hosipital to be treated with dioxin to correct the A Fib.  The second attack occured and I diagnosed myself before getting to the hospital.  Back to the large meal and gastrointestinal relation.  Although most Dr's will not correlate a relation to A fib and Gastrointestinal problems, I can firsthand tell you that there is a direct relationship.  Whenever I have a large meal and feel bloated I can feel the xtra pressure within the stomach and notice the A Fib are more frequent, especially if I lay down.By loosing weight and eating smaller meals the problem ease quit a bit.  Hope this helps.  I wish the medical community would study this senereo in order to come up with better treatments.

[JR]

look on here for posts by a guy named "mr. stomach".....
hes on to something. i completely cured myself of pvc's and
psvt caused by stomach problems.....

[Conrad]

I have had a-fib for 10 years.  I have been on Digitalis,Quinadine,cordarone, enderol, and now rythmal. Each helps some, but nothing stops it. I went through a mapping procedure with the hope of an ablation solution recently with failed results. I agree with Peter about the pressure relating to the diaphragm.  I get the same symptoms with the gurgling or the feeling of gas moving near the right of the sternum. There is a quivering sensation that precedes the a-fib. If I massage the right diaphragm it sometimes stops the a-fib from occurring. So recently I tried taking some simethicone as the symptoms began.  It is too early to tell, but it did relieve the symptoms that time at released some gas pressure from between the diaphragm and the heart.  I suspect that somehow this pressure starts a spasm in the vascular system that carries up to the heart resulting in a-fib.  Once it starts, it takes 18 to 24 hours to stop.
It seems that most cardiology experts dismiss this as anecdotal. From a lay person with a 10 year history, this seem like tunnel vision.  I challenge them to consider the connection and research the link.

[RCA tues Dec 19,2000]

Comment to Annie. At 73 I to was diagnosed with A- fib and put on cardizen, prozac, aspirn ect. My fib most always came between 2 and 6 am. I was put on cardzin, prozac,aspirin ect, which upset my stomach to a great degree{ I have a quezzy stomach and small ulcer for which I have taken Tums}.Taking all these drugs caused my stomach to become worse than the fib, {isnt that usually the case}. So about 1 month of experiencing the fib and bad stomach I started taking 150mg of Zantac for my stomach, you can guess the rest, the day after taking the zantac the fibs were gone. I know Dr's say there is no connection but after reading your note and the many replies I had to add my own two cents.I must add this is only about 2 months after my hospital stay and diagnosis and things may change but so far so good

[hes right]

i (almost) completely cured myself with previcid on a hunch...my internist prescribed it to me, and 2 days later...not as much as maybe 1 or 2 skipps a day down from hundreds!!!!
thank you mr. stomach or whoever!!! you are a scholar and a gentleman.....

[Anxious]

skipping beats right now. going to the drugstore for some zantac today after work....ill right back and give the results!

[i may have an idea]

the new stomach medicines block a type of histamine that triggers the production of acid in the stomach...could this histamine also have a negative effect on electrical conduction in cardiac muscle? histamine does some pretty weird stuff to the body, and stranger things have happened in sure. im no freakin doctor, but i just wonder sometimes if these "booksmart" yahoos in lab coats ever just put 2 and 2 together to get 5?

[Jimmc]

I have had PAC's for years, usually at night in bed.  My cure was getting up and having a glass of milk.  Two years ago I started with A-Fib.  everytime I have A-Fib or PAC's, I have indigestion.  The Dr. says baloney.  I'm glad to know I'm not alone.

[Anxious]

its like a whole new world for me now!
pvc's are gone....by bye....sianora! previcid is the ticket
doc also put me on tenormin, but i think fixing the stomach did
more than anything....why wont anyone catch on to this? doctors seem to shy away from anything they cant explain.

[bill]

I am glad to read of all the people who experience the same or near same symptoms i am having. My atril fib is always triggered
and i mean every time from belching!As soon as  my stomach calms down so does the afib. It just goes away.My doctor did not know of any connection bettween these symtoms but the vagel nerve goes right down the esophogas( right spelling i hope?). I asked if the pressure from gas build up,in my case belching could irritate the vagel nerve and cause the jump to atril fib.He seemed to think this was the case.

[micki]

My husband Robert has been experiencing similar problems for the past few days. He got sick at work the other day -- he started belching almost constantly. Then he began to experience irregular heartbeat. He noticed that everytime he would belch, his heartbeat would become irregular. He works at a new job that puts a lot of stress on him and had been on a diet, eating mostly fresh fruits and vegetables and drinking a lot of orange juice for a couple of days. His stomach stayed really bloated and his throat started to burn when he belched. He could feel a flutter in his stomach each time before the irregular heartbeat would start. If anybody has any more information about this or possible treatments, please right us at ***@****

[micki]

My husband Robert has been experiencing similar problems for the past few days. He got sick at work the other day -- he started belching almost constantly. Then he began to experience irregular heartbeat. He noticed that everytime he would belch, his heartbeat would become irregular. He works at a new job that puts a lot of stress on him and had been on a diet, eating mostly fresh fruits and vegetables and drinking a lot of orange juice for a couple of days. His stomach stayed really bloated and his throat started to burn when he belched. He could feel a flutter in his stomach each time before the irregular heartbeat would start. If anybody has any more information about this or possible treatments, please right us at ***@****

[micki]

My husband Robert has been experiencing similar problems for the past few days. He got sick at work the other day -- he started belching almost constantly. Then he began to experience irregular heartbeat. He noticed that everytime he would belch, his heartbeat would become irregular. He works at a new job that puts a lot of stress on him and had been on a diet, eating mostly fresh fruits and vegetables and drinking a lot of orange juice for a couple of days. His stomach stayed really bloated and his throat started to burn when he belched. He could feel a flutter in his stomach each time before the irregular heartbeat would start. If anybody has any more information about this or possible treatments, please right us at ***@****

[alexi]

I think I came to the same conclusion. It has to be related to digestion. Both my doctors (internist and Cardio) don't agree, but I have a strong feeling that it is. PVC has been with me for two years now. I am 40 and physically fit and exercise a lot. No problems at all: not shortness of breath, no fainting, nothing.. just the annoying feeling of those strong heart pumps...

"Anxious" how are you feeling so far? still PVC free? I really like to know.  

Also, how can I find info. on Roemheld Syndrom (syndrome)? anyone did any research?  

"Jr"  where can I find posts by "Mr. Stomach"??

[Anxious]

a world of difference....even a month later.
better than ever maybe. i cant remember when i felt this
good. like a weight has been lifted off my back. almost to
the point now where i never have the skipps and thumps.
maybe just 1 or 2 a day if ever. i would recommend giving it a try if you can, and also if you drink alcohol....even occasionally, stop for awhile and see if you improve. spicy foods too.

[alexi]

Anxious,

Thanks for the reply. I also has this sneaky suspecion that mine has a lot to do with my digestion.  What did the trick for you?  was it:  Zantac ,  Previcid,  or tenormin?  or perhaps a combination?  I appreciate you sharing this with us here...

[Anxious]

i think it was the zantac more than anything else really, but i did start on a low dose of tenormin (atenolol) 12mg X 2/day....on that low of a dose twice a day, side effects are minimal... the biggie i think was 150mg zantac in morning, 150 in evening or 75 if it will do.....you can get it over the counter now at 75mg, but if insurance will pay, have your doc write you up for 150, itll save you $$$ in the long run.
hope this helps you....i know it did for me.
good luck

[tom]

Alexi ,
Did you discover where to find the posts of Mr. Stomach ?

[Lauro]

Reading with ernest all the posts.

I have had a terrible 2000 year with gastro/breathing/throat and heart like symptoms.

Mine all related to one another.   You betcha.  But, you cannot tell a physican this.  I KNOW my body and I KNOW what tics and what does not tic.

Still fighting the battle as Proton Pump Inhibitors do not work for me,  I.e. prevacid, prilosec and Achifex.  (may try the prevacid again)

Zantac and watching what I eat and Mylanta Extra Strength is my companions now.  I do have a hiatal hernia per the EDG and Reflux per the EDG (neither, I was told is really bad)but now I am taking charge and diligently trying various lifestyle changes, elevating the head of the bed with bricks, avoiding stresses.  My biggest complaint right now is the upper abdomen swelling and the dypena (shortness of breath)  BUT, I feel confident that "this too shall pass".  

The heart palps that I have also expereinced, I feel, are all related to the Gastro problems.   Good Luck To All.

[Jacki]

I truly believe there is a connection between Afib and GERD(gastroesophageal reflux disease.) I was diagnosed with hiatal hernia in Feb. and started having episodes of Afib&Flutter in July. Was in hosp.overnight and referred to a specialist in Toledo. Am currently on Tambacor and take Zantac as needed. My cardiologist isn't sure there is a link between GERD and Afib but he says it is possible. After reserching this, I am convinced there is a connection. I see a gastroentrologist this week. We'll see what he has to say.

[Lauro]

Please share with us what your gastroenterologist may say on this subject.  heart vs. reflux.

Thank You.

[Jacki]

Lenore,
I will be glad to share whatever info I get. I am so glad I found this forum as I had a feeling my episodes of Afib were related somehow to my hiatal hernia and reflux but hadn't talked to anyone else who had both these symptoms. Other online sites I have read also confirm that a lot of people feel there is a correlation. I'm anxious to see how the gastroenterologist feels on this subject. Thanks and will keep you informed.

[arthur]

The connection between digestive disorders and arrhythmia is likely a subtle one and is likely caused by irritated pulmonary veins.  The most recent research has found that the pulmonary vein ostia (openings to the atria, left and right) contain varying lengths of cardiac muscle tissue which have the tendency to fire off their own sets of signals.  Once these PVs get a bit stressed (causes not clear, but lifelong exercise, age, virus are suspected) they tend to behave much like a muscle tic, sending out abberant signals, some of which are picked up by the atria and conducted into the heart, thus appearing as premature atrial or ventricular beats...mostly atrial.  These PVs have been definitely identified by EP tests as responsible for PACs and PAF.

One cute characteristic of these excited PVs is that they are sensitive to physical changes, ie, changes in posture, movement of diaphragm (like when you get gas, or are bloated from a meal).
Apparently, changes in physical pressure on the PV system will change the characteristics of the hidden tic.  This tic has been reported by many as a "nervous feeling" or "internal tremor" centered in the chest.

It is likely that most, of not all, atrial premature beats arise from these excited PVs and that pressure up into the thoracic cavity will alter how these PVs behave.  I hope this finally answers the pervasive questions about GI and arrhythmias.  

Most cardiologists may not be aware of this connection.  Most electrophysiologists (EP) will acknowledge the possibility.

[Lauro]

This is a wonderful post and very informative.  I have to agree that most likely a general cardio doc will not be aware but isn't that a shame.

They have many heart conventions and I am wondering WHY this is not brought
up at conventions so ALL cardioologists, genral and otherwise
can learn of a connection.

I am a sufferer and it has been *&$%^%$%^ trying to put the pieces together myself.  I would rather be needle pointing and or crossstitching inseatd of researching.

Michael Brewer posted some very good information under one of the
Arryhtmias sites/January 19,2001.  Makes sense to me.

Thanks for this information.

[Jacki]

I'm sorry I have not gotten back with you regarding results from gastroenterologist visit but I didn't get to see him as his office did not accept my insurance(blue cross/blue shield preferred. I was stunned as I have never had a problem in the last 10 years or so of having this ins. So I had to make another appt. with a different dr which isn't until 2-26-01. Meanwhile I am still searching for answers. If you haven't yet read Michael Brewers comments, they are interesting and informative. Does anyone know what or who the Arrhythmia and GI connection is? Just wondering. Best of health to all.

[arthur]

Just to set the record straight...the arrhythmia/GI connection is simply me, an individual who has spent a huge amount of time researching the literature and discussing these topics with cardiologists (as a result of my own arrhythmia problems which were traced to overactive pulmonary vein foci).

My own experiences have led me to believe that when confronted with symptomology that doesn't quite fit a single area of specialization, the MD specialist is generally unable to diagnose the condition.  Our medical system has made it impossible to find a generalist who has the knowledge base and experience to perform accurate diagnoses.  So, when one organ affects another, good luck tracking it down, since each organ is part of a different specialist's area.

The things that affect the heart are numerous and span beyond any single specialist's area.  Add a nervous system connection and you basically enter the land of speculation.  You would think a neurologist might be consulted here, and you would be wrong.  The sad fact is that the nervous system interplay behind and around the heart is beyond our present day understanding...that is why most cardiologists either prescribe anti-arrhythmia medications on an empirical basis (ie, try this and see what happens) or they suggest that these arrhythmias are benign and that you should get used to them.

It's a wonder that anyone stumbled upon the pulmonary vein connection...this has led to the current fad of blaming most atrial arrhythmias on the cardiac tissue inside the pulmonary vein connections to the atria...and to the current surge in using RF catheter ablative cures.

Well, enough ranting.  I suspect we will see some neat science emerge in the next couple of years that will make even our common  PACs acceptable targets for novel and safer ablative intervention.  We just have to be patient.

[Jacki]

To Arthur
Thank you for your interesting post. I totally agree with you that finding ONE dr. who can get to know you and correctly diagnose your problem is rare. I have not had to much experience with this runaround approach until this past summer,but my father has several drs and it is almost impossible to figure out what is going on with his meds, labs, not to mention who to call when there is a problem. It's frightening to think but true that we all need a patient advocate with us to make sure we get the care we need and deserve. I have fallen into this role for my father as well as for myself. Thats why it is so important to be as informed and involved as possible, which you seem to be, in our medical care.
Please keep us posted on any new updates.