Can neurologists help with ANS disfunction?

[Robb S]

I have a very sensitive vagus nerve, aka high vagal tone.  Symptoms are bradycardia, low body temperature, low BP, hoarseness and most annoying, vagally triggered atrial fibrillation.  I have had an ablation and am still waiting for the final outcome (when the healing is complete).  My afib episodes are almost always the result of eating something spicy or drinking something cold, or contraction of my abdominal muscles like when lifting weights.  As an alternate path to the work on my heart that I have had I am thinking of getting treatment for my overactive vagus nerve.  Would a neurologist be able to diagnose exactly what is irritating my vagus nerve when an episode of afib is triggered?  If so, what type of treatment could be given to either stop the offending signals or lower my general vagal tone?  I have mild reflux and know that the esophagus is innervated in many places by the vagus nerve.  Would a gastrologist be a better specialist to see regarding this issue?  I talked to my GP about this and he believes that the neurology department at a major medical center in the metro area works with ANS dysfunction.  Should I check into it?

[Robb S]

Thank you for your comments.  I am not an avid weight lifter but have run/jogged for most of my 57 years.  I am tall and lean, the typical profile of a canidate for afib from what I have read.  I am already doing several of your suggestions to minimize the reflux, and it isn't a bad case but sometimes it doesn't take much to start the spasms going over my stomach area which often leads to an afib episode.  The sensitivity runs in cycles and once an episode of afib is over my vagal tone seems to return to a lower level for a few days.  I will seek a neurologist that has background in working with the ANS and see if he or she can help.

[Dr. Kokil Mathur]

Hi!

You mention that the episodes of high vagal tone are triggered by lifting weight. Do you do this regularly. If yes, then this could be one reason for a high vagal tone. If you combine weight lifting with any other form of exercise such as running, jogging, swimming etc, then it can trigger an increased vagal tone. Most sports persons have an increased vagal tone.

If the vagal tone is triggered by spicy food and exercise, then cutting down on both will help reduce the symptoms. Your GI specialist should be able to help with the reflux. Also, keep the head end of the bed raised, eat 4-5 small and well placed meals (eating in bulk also triggers the reflux) and take medications to keep the reflux under check.

Yes, neurologists can help you to some extent. You will need a detailed evaluation of the complete autonomic system to understand the type and degree of autonomic dysfunction. Also you need to be tested for Parkinson’s disease, autoimmune disorders, diabetes, and endocrine disorders. If the autonomic dysfunction is due to any of these underlying conditions, then treating these conditions will keep the symptoms under check.

The neurologist can also prescribe some medications to decrease the vagal tone and prevent further episodes. Also, you will be advised some lifestyle and diet changes to be followed for life.

Please discuss all this in detail with your doctor. Hope you get well soon! Good Luck and take care!