Hard (not fast) Palpitations, Specifically After Eating

30yr old male.  5'9", 190lbs.  “Hard” palpitations for the past 6 years (normal heart pace/rhythm). They are most significant following meals. Intensity and length are directly related to size of meal, sugar/carb content, and other undetermined ingredients.

Generally, if I eat a sugar rich meal, within minutes my mouth will get dry and sticky. Approximately 30 minutes later the palpitations will begin.  Intensity will increase for 30-60 minutes. They can last anywhere from 1hr to 12+hours (depending on size/type of meal). The palpitations are usually so strong that I can feel my heartbeat in my extremities, hear it in my head, see certain arteries pumping, and it even moves body parts such as my stomach/chest, can close my jaw if teeth are left millimeters apart, and twitch my leg if crossed over the other when sitting.

The known potential contributing factors are: overweight (220 at highest), poor diet (a lot of fat/meat, not many fruits/vegetables), not handling stress well, on/off exercise, and binge drinking (since high school, once/week, 6-15 drinks). Through the last 6 years I have made intermittent and varied improvements in all areas without symptom improvement. More importantly, 3mo ago I eliminated all above with drastic/permanent lifestyle changes.

I have seen heart, pulmonary, endocrinologist, natural, and psychiatry specialists. I have taken numerous tests, all negative. I’ve tried multiple meds, an at home glucose test, and acid reflux meds.  I am currently taking Nadolol which does seem to help a little bit. Since the palpitations began, my BP was borderline hypertensive (13x/8x), but it has recently been low (11x/7x).

I would greatly appreciate any suggestions anyone may have? Are there any other specialists, tests, medications, diets I could try? Does anyone have any insight specically what my be causing my heart to beat harder (ie internal chemicals/processes/reactions)? Where do other patients turn when a diagnoses cant be found?

Thank you!

[CCFHeartMD20]

Hi Sbrushworks,

It's obviously hard to answer these questions over the internet, but I can give you some suggestions based on your description.  The most likely explanation for what you are experiencing is that you have acid reflux brought on by certain foods.  It seems like you are trying to change your diet, but here are some suggestions.  Do not eat within several hours of going to sleep.  Avoid the following foods: chocolate, alcohol, spicy foods, very fatty foods, etc.  You should also continue to work towards losing weight.  Try completely following these recommendations and see if your symptoms go away.  As for the reflux medicines, if you haven't tried medicines like pantoprazole or omeprazole, I would try that specific class of medications.  Take it 30 minutes before the first meal of the day for greatest effect.  If these things continue not to work, you could consider seeing a gastroenterologist to see if it's worth using a camera to look down to determine if there is some mechanical cause for your symptoms.  This is assuming your awareness of your pulse is from reflux (which by your description, seems most consistent with this).

The other things to consider are getting a Holter monitor to monitor these episodes when you're having them to see what they are (this may have already been done by your cardiologist).  The other thing I would consider is an echocardiogram to make sure there is nothing going on structurally with your heart.  You should also have your thyroid checked (likely the endocrinologist did this).  If you are using any recreational drugs, over-the-counter supplements, herbal medications, weight loss regimens, I would discontinue and discuss with your doctor.  Also, exercise tends to often help with these types of sensations (I would clear this with your doctor).

Hope this helps!
CCFHeartMD20

[is_something_wrong]

Just to add (I'm not a doctor, but I'm occationally suffering from the same as you describe):

After eating a meal high in sugar (or other "empty" carbs), your pancreas release lots of insulin to make the cells take up sugar (using it for energy and lowering the blood sugar levels). What actually may happen, is that your blood sugar levels drop too low which again makes your body produce adrenaline (and a few similar hormones) to release sugar from the liver, to normalize blood sugar levels. This may cause palpitations.

A method to test this is to buy a blood sugar monitor (in my country the cost is equal to $10-15 for the cheapest one, you don't need an expensive one as you are not diabetic and only using it for a brief test). Measure your sugar before eating, 15 minutes after eating, and when you experience palpitations (each 30 minutes for a couple of hours). If your sugar drops lower an hour after eating or so, that may be the answer.

Also notice that the heart is supposed to beat a bit harder (or faster, or both) after eating, that's how the body ensures blood supply both to the GI tract and the rest of you. Arteries dilate after eating too, so your heart beats can be more noticeable when checking the pulse.

Are you eating very fast? If so, try to slow down, to avoid a so-called "gastric dumping syndrome" (google it), which may also cause palpitations. A huge intake of sugar on an empty stomach will cause palpitations in most of us I think.

Take care :) I hope you find the cause of your palpitations!

[sbrushworks]

Thank you very much for the post!  You are the first medical professional to suggest acid reflux as the possible cause.  I am going to do some research and get to work on your suggestions right away.  Thankfully all the additionally mentioned tests you suggested have already been completed and came back negative.  Sincerely can't thank you enough, this issue has frustrated me for years.  

[sbrushworks]

Thank you very much for the post!  I appreciate the explination of what may be taking place.  I had bought a blood sugar monitor, but did check the same way you have suggested.  Have also never heard of gastric dumping syndrome, but I do eat fast, and the meds CCFHeartMD20 recommended for Gastric Reflux can treat this as well.  Am going to try all, then if no help see a gastroenterologist.  Thanks again to you both!

[sickofbeingsick777]

I would be very interested to hear what happens.  I have suffered something very similar for nearly 3 years.  I get extremely tired with the palpitations and short of breath when this is happening.  I have been tested for so many things and my doctor simply doesn't know what to do anymore. I get so tired sometimes I cant get out of bed (the morning after the offending meal) and I have had time off sick from work.  I am going to consider acid reflux now as well.  By the way, how much coffee do you drink?  I have been reading some worrying things online about it damaging the stomach lining - and it is meant to make acid worse.  I share your frustration about what happens to people who do not have a diagnosis - its so awful to have no hope of getting better and no one who understands, and no official line to give your boss.

[sbrushworks]

sickofbeingsick777

Doctors have ruled out acid reflux.  As stated above, I suggest geting a blood glucose monitor and checking your blood sugar any times you feel the palpitations, with a reading of below 60 being a red flag (fortunately/unfortunatley mine never dropped below 60).

I do not if we have exact same issue as I do not get tired with mine, although I have personaly started to look into panic disorder.  I originally burshed this possibilitiy off as I am a normal 30yr old with a great job, family and friends.  Although after further research about the topic I feel there is a strong possibility.  I am currently reading "When Panic Attacks" by David Burns and am planning to discuss all with my primary physician.

Last, unless there is some other reason, I would suggesting being truthful with your boss, don't see how someone could not be sympathetic to these types of issues.  Good Luck!