vagus nerve, GERD related arrythmias

[pvctom]

I have just read some interesting articles that have given me some much needed insight and comfort for my current bout of ectopic beats, which have been on and off, mostly on now for 10 weeks. My holter done back on April 8 showed 5300 ventricular beats in a 41 hr read. since then, not as many, but they still go on and then go away for awhile and then they come back again. Since reading these articles I am able to better understand why I get the ectopic beats. I am eating much lighter, and This seems to help. GERD and belching seem to accompany these pvcs.

thanks

[marlinspike]

Over on the All Experts Heart Forum, Dr David Richardson often recommended flecainide for pvcs. It doesn't seem to be widely known in the UK, but may be worth looking into for some folks. It's probably worth saying that I get the impression that doctors prescribe bb's to alleviate the unpleasant sensations of palpitations and to take the edge off the anxiety - they are not given because pvc's are harmful and must be suppressed for health reasons. When I went to A and E with bigeminy, I asked the cardiologist if I needed to take beta blockers and he said not.

[hefner33]

Thank you sir

[Artaud]

Relevance of intrinsic sympathomimetic activity for beta blockers.

http://www.ncbi.nlm.nih.gov/pubmed/1977302

They cause slowing, just not as much. It's an old article, 1990.


Beta-Blockers, Intrinsic Sympathomimetic

http://reference.medscape.com/drugs/beta-blockers-intrinsic-sympathomimetic

pvcTom first brought them to my attention. My E.P., an older gentleman, thinks highly of it. Let me know if you need more.

[hefner33]

Hey.

Where'd you find the information on the above beta blocker that does not cause more slowing of the heart rate? I want to show this to my dr. Thanks

[pvctom]

Hi Artaud,

Yes, I would ask your Doctor about the Sectral. I am going to mention it to my GP when I Email her. The problem is, sometimes, when you get meds like I do from my Military Installation, you have to take what is on there formulary, or get a special order written for the drug you are requesting. Sometimes, in the case of Beta Blockers, I, or the doctor would have to justify that all other meds did not work, and since they are prescribing my Beta Blockers for hypertention, it would get sticky. I'm not sure how much Sectral would cost on the outside.

I also posted earlier under a different question, that I had been given an off label med call Ranexa. I am reluctant to try this one. But anyway, I wish you luck and peace with your swallowing, eating, and PVCs discomfort. And I can only say that, maybe, if your Doctor would approve, you might benefit from aciphex for GERD, reflux, acid overproduction. It has helped me with that, however, when my PVCs act up, they just stay around and drive me crazy.... that's when this forum gives me great comfort. best to you.

[Artaud]

Thanks much. It has a few properties that make it unusual.

1. Intrinsic sympathomimetic activity. It helps to prevent Bradycardia. Also helps to prevent the Bronchial Restrictions caused by Beta Blockers, even though it's a selective Beta Blocker which usually isn't known for that.
2. Having the sympathomimetic activity may allow the sympathetic influence on the heart to remain stronger, perhaps offsetting the swallowing induced arrhythmia I am currently afflicted with.
3. It's not known to raise cholesterol, something that most of the other Beta Blockers do.

Very interesting, thanks much, I'll be researching it.

[pvctom]

hi Artaud,

just to let you know, I once tried the beta blocker sectral, and I went pvc free for many months. this was back in the 90's. however, when I started being treated by another cardiologists, they switched me to lopressor. just thought i would let you kow about the sectral. i have not heard of it being used recently, but once upon a time it seemed to work well for me.

[Artaud]

The sitting thing, I've noticed that. Fortunately it was caught on the Holter as well. When this bout first started, I had bigeminy, trigeminy, quadrigeminy, what ever every 5 beats would be, but now, my nemesis is bigeminy. Oy vey, I'd take quadrigeminy anytime, at least you get three normal beats for one premature beat. The odd thing is that I read an article that said quadrigeminy can actually be concealed bigeminy.

I can be sitting, long strings of bigeminy, then get so nervous that I jump up due to the tension (it takes a while, but eventually it gets to me) and walk to the kitchen, and I go into a normal rhythm or just isolated premature beats. When I sit down, bigeminy again. Ugh!

I can live with these, I've had them for 40 years, but I would like to experience fewer of them. The first E.P. remarked that Atenolol is a weak Beta Blocker, which surprised me, and I haven't found an article specifically mentioning that. I'm going to ask the new E.P. if a change of Beta Blocker may reduce the number of premature beats.

I did find this article on Beta Blockers, rather interesting.

http://m.circ.ahajournals.org/content/107/18/e117.full

It said there's 16 Beta Blockers in the U.S., 15 with oral forms and one injection only. Sotalol, not in the same class as many of the other Beta Blockers, requires monitoring to safety titrate, at least from what I read, and I'm not sure if any others do as well. Paradoxically, there is this group as well: "Some drugs are weak stimulators of the β-receptor while still blocking the major actions of catecholamines; they are acebutolol, carteolol, penbutolol, and pindolol.". Strange, they stimulate the Beta Receptor and Block the effects of epinephrine and norepinephrine. It's like having a fire extinguisher that sprays a little fire as well.

[pvctom]

thanks for your reply. I agree, doctors seem to dismiss it. i am not a medical person, but, this digestion, and positional thing, I believe, mostly when sitting, and after a meal, seems to irritate, or cause the arrythmias.

[pvctom]

thanks Artaud. i have been driving on the road for 8hrs, constant pvcs, pacs, or whatever they are. sometimes when I'm confined in a sitting position, this also aggrevates them. thanks again for your reply.

[Artaud]

You may have missed this, I believe I've posted it before. Very interesting coverage on the topic of gastrointestinal disorders and associated heart arrhythmias.

From the British Journal of Cardiology

"Cardiac manifestations and sequelae of gastrointestinal disorders"

http://bjcardio.co.uk/2009/07/cardiac-manifestations-and-sequelae-of-gastrointestinal-disorders/

This article covers arrhythmias from swallowing. Some of the people studied and treated actually passed out when swallowing from a neurally mediated vagal response. Elsewhere, I've read articles of people that pass out from shaving, the pressure of the razor on the throat effects the carotid artery, which elicits a vagal response, and boom, unconsciousness.

The medical community is aware of this, why won't our doctors, pardon the pun, take it to heart?

[Artaud]

Hi Tom, I started on Verapamil, an interesting thing happened.

I put myself back on the Beta Blocker until Monday, I have another appointment with a different E.P., and I want to hear his suggestions first.

I'm a life long Beta Blocker (BB) user, so the one day switch to Verapamil easily showed me something I had read but not experienced. Beta Blockers limit the influence of the sympathetic nervous system on the heart, Calcium Channel Blockers (CCB), like Verapamil, do not. A trip to the top of the stairs later the day I switched to the CCB had my heart pounding, something I've not experienced, in years, under similar exertion. Yet the resting rate was slow. Adrenaline is my nemesis, Beta Blockers limit the influence of  Hormones known as catecholamines (norepinephrine, epinephrine). Adrenaline is epinephrine.

One point in the vagal cause debate is whether or not the problem is an overactive parasympathetic influence or an underactive sympathetic influence. On an individual basis, they find evidence for both (one thing in one person, another thing in another, but similar symptoms for both). Nevertheless, the principle is the same, you can have  non-cardiac causes producing cardiac symptoms.

The reason I'm seeing a second E.P. is that no one wants to address the Vagus nerve. My neurologist said they don't do Vagus nerves. The first E.P. was disinterested. If my heart goes insane when I eat, might it not be best to see why the vagus nerve is causing such a fuss than to just keep throwing medications at the heart?  

This has been an eye opener for me, a preview 2 years ago with isolated ectopics when I swallowed solid food, and then only towards evening. Now, pandemonium breaks out when I eat, you would think it would pique someone's curiosity.

With GERD, Hiatial Hernias, and other digestive disorders known to cause irregular heart rhythms (at times) one would think that diagnoses would shift that way for specific patients. Apparently the medical community is not there yet.