Arrhythmia caused by vagus nerve

[robb]

I have had short arrhythmias that seem to be triggered by activity in my stomach or abdomen. These arrhythmias have become more frequent and longer lasting in the last few years. Events that seem to trigger the arrhythmia can be eating spicy food, an extended period of GERD, leaning forward for extended periods while working at my desk (crunching the abdomen), pulling on a wrench while working on my car, and even stretching. I believe that my vagus nerve gets extremely sensitive from time to time and gets irritated by the stomach or abdominal muscles. When the nerve is on edge I can feel pulsations about 1" above my navel. This can, but does not always, lead to arrhythmia. Once the arrhythmia starts there is nothing that I can do to stop it until it runs its course. I have had a stess test, heart ultrasound, etc. and my doctor says that my heart is fine. He said that the arrhythmia is an atrial flutter. It isn't a fun experience when I am having this because it limits my physical activity. So the question is, what is the next step to take? Should I see a neurologist, a gastro-intestinal specialist? Would vitamin B help calm this nerve? Could this be something else like a hietal hernia?

[robb]

I may have found a solution to the sensitive vagus nerve issue. About a week ago I began taking a Sam's Club Mult-B Vitamin twice a day. Within a day I noticed that the jumpy feeling of the nerve over my stomach had almost completely dissapeared. I have since tried some things that had irritated it lately and so far so good! I have been under some stress at work for several months now and I think that it had taken a toll on my nerves. I will continue to try more strenuous activity that has set off the vagus nerve this weekend. Taking vitamins will be a cheap solution to the problem. By the way, where is the expert in this forum? I put my inital post here about 3 weeks ago and have had zero replies.

[Phil]

Ditto Rob on virtually all that you described. I am becoming convinced that some kind of vagus nerve aggravation is causing the unpredictable heart flutters that I have been experiencing over the last few years.

When symptoms occur, it's literally like there's a just-left-of-center "string" of inflammation, extending all the way from my left eyeball down to the left/central section of my lower abdomen. Most often occurs after eating, reclining, bowel evacuation, or stress (physical or psychological). Spicey food also a significant irritant.

Would be nice if an expert could comment here. I have had every non-invasive heart test there is (eg, treadmill, chest x-ray, EKG, coronary ultra-sound; even a CT scan & enzyme-checking). All results show "negative". My cardiologist doesn't seem "alarmed" by anything I tell him, but I am almost as tired of hearing that as I am of the symptoms themselves.

[nightshade]

Gentlemen,
I have been experiencing similar symptoms and had come to the same conclusion. Formerly very athletic and have been through lots of cardio tests over the years for a variety of purposes (guinea pig, stand in for training for such tests, army research... you name it). Have been very sedentary and gained a lot of weight in the last 10 years. Three years ago had what seemed like a minor cardiac event that was triggered by light activity and eating a large mouthful of moderately spicy/greasy food. Had a pretty thorough workup - treadmill stress test, holter, bloodwork - only to be told it might be'indigestion' and was put on Prilosec for a month. Couldn't stand the stuff after about two weeks, and stopped taking it. Cut back on coffee (was a prodigious coffee drinker, but had Never, EVER had any problems w/caffeine despite stressful life situations and poor health habits), and gradually got fitter.

Lost a lot of weight, but let myself slide and now I'm back to being very overweight. Couple of months ago, the symptoms came back, triggered by eating (I should say "bolting") two dry bagels washed down by a cup of cold coffee at work. Was exercising regularly for the three weeks prior and feeling great about it - during and after. Was drinking loads of coffee and under a lot of cognitive and emotional stress, too. But the episode was DEFINITELY associated w/the bolus of food. Basically my heart stopped long enough that I nearly passed out.

I get the "how do you know" response from the technicians and doctors all the time. I know because after the prior experiences my first thought when I felt like I was having a funny heart response was "here we go again", and I immediately checked my pulse at my wrist. Nada. In the next few seconds I tried my carotid - nada. As I was starting to experience tunnel vision and beginning to black out I took a really deep breath in hopes it might somehow help and I had a massive heartbeat in my chest and my normal rhythm resumed. I sat there for a few minutes in a cold sweat and then got back to doing a bit of work the rest of the day. Thought about heading to the ER, but after spending months chasing similar symptoms two years ago, I figured it was not going to help (and so far, in follow-up, it hasn't). Had some couplets and a few runs of VTach over the next week, and I wonder if there was some focal damage or an irritated foci of some sort that is now helping trigger irregular beats. So, have since been seeing a cardiologist, but it's more of the same: "PVCs are normal"; I don't have "a lot" and seem healthy otherwise so he's not worried; did another holter and stress test and they were normal, tho' there are more PVCs now than 3 years ago...so far the most 'helpful' advice has been to begin to lose weight again and watch my diet.

I'm a former exercise test technician, so I know how to take pulse rates (mine and others'), and have been involved in lots of testing as a surrogate for practice and research. So, I know that periodic PVCs are not normal for me, which makes me wonder if there was some other focal trigger. My PVCs or ectopic beats happen when I've had certain types of spicy food now (again, NEVER a problem before - I am the hot sauce/tabasco guy in the family!), or if I've overeaten the least little bit. Drinking caffeine seems to make me more susceptible, as does any food that sets of gas or indigestion. It's atypical, 'cause I've had a "cast iron stomach" for decades - army food, spicy food, junk food, roughage...never mattered before.

My general practitioner and I both came to the same conclusion before I went to the specialist - possible vagal irritation. Question is, what to do? Smaller bites, I guess. Back to Prilosec for a while, perhaps. Cut further back on caffeine (<= 1 cup/day or none at all). Back on the treadmill to exercise a little bit at a time until I get the gut out of the way of the rest of my innards. NOBODY has any very helpful information on it. Typical tombstone medicine it seems - wait until it becomes serious, they deal with it. It's annoying to have such a persistent and clear change in my health and day-to-day wellbeing (I get the PVCs at just about every dinner meal now, even if I'm careful about how much I eat), and be told that it's not serious by comparison.

While vagal irritation is a great theory and my plan of action in my opinion is sound, it doesn't help eliminate the possibility that there still is some underlying heart disease that is triggering this now. I've got a follow up w/my cardiologist and I plan to grill him on all the remaining stuff that should be ruled out, the tests to run to do so, and the probable value of doing them. Meanwhile, it's back to the treadmill and the over-the-counter indigestion section.

As for the multi-B vitamins...I've been taking multi-vitamin supplements regularly for ages, including multi-B. Vitamin B deficiency can cause neurologic problems, but I don't know about it helping something like vagal irritation.

There seems to be conflicting info in the literature I can find about the vagal nerve, too. But, much points to the possibility that GI irritation can affect the heart through the vagal nerve. Again, I just don't know what to do about it other than over-the-counter stuff and behavioral changes to reduce GastroIntestinal irritation.

Best of luck - I don't expect you'll get any joy from a physician on this issue. I've been poked, prodded, listened to and humored. Love to hear from an experienced MD about this; however, most seem to be very conservative about even venturing an opinion or discussing a connection between vagal tone, indigestion, and arrhythmias. Very frustrating.

[kevin]

Great post,i'm in the same bag as you guys.cardios dont want to know about stomach problems,gastros dont want to know about heart problems.going to a heart rhythm patients convention in october with a bunch of questions for the experts,hope to find some answers. good luck to you all and hope the dreaded palps come to an end.

[aechef]

I've been surfing sites and postings like this for about 3 years, finding people with the same symptoms. Doctors don't seem to be very on top of PVCs and PACs caused by stomach issues. Nonetheless, I think my gastro-e has fixed mine. After all the usual heart testing, couple of emergency room visits, adrenalectomy to cure pheochromocytoma, I finally got a colonoscopy. I was diagnosed with IBS and put on 10mg Amitriptyline at bedtime. MIRACLE CURE for the heart symptoms - they have been gone since the first dose, 3 weeks now. It's amazing how well this stuff works, it's cheap, and low risk - talk to your doc about it. Hopefully this will be of value to others. I'm off to post this elsewhere now! Good luck.

[andwes8147]

Boy, am I glad to hear all this great information. I have been plagued by irregular heartbeats on and off for forty years! Oftentimes they'd go away for 3-4 years, then come back with an episode lasting weeks to months. The testing I had when I was younger all came back fine - and docs attributed it to stress AND indigestion. I haven't had them now in four or five years and suddenly a couple of weeks ago they started up again. I am under stress at work, etc. but I'm wondering if now that I'm older (62) this could be something serious. Interestingly though, I too suffer MUCH more after I eat....I can belch for an hour, get all this gas up and usually the irregularity calms down. No one can tell me it doesn't have something to do with the Vagas nerve - I think we all know our bodies better than most doctors. I had read that magnesium and potassium also help to relieve these symptoms so I'm about to go out and get some to see if they help. It's a very uncomfortable feeling to have these irregular beats though - always feel like one of these times I'm just going to keel over.

One other thing I read about the other day was breathing exercises for relief of arrythmias. I know that when I'm anxious or stressed I tighten up and take much shorter breaths. When I consciously breath in an out completely, the arrythmia subsides. I also read that someone felt that orange juice was very helpful but I haven't tried that yet since I'm nore concerned with the acid bothering my stomach.

Well just wanted to offer my suggestions.

[jpek]

Hello and Thank you.
I have very similar symptoms and have little luck with finding a possible solution to this. The combinations of stress, sleep deprivation, foods that are difficult to digest all seem to have a negative effect on the system. It seems that this is very common and is often dismissed by physicians as not serious despite the impact it has on an individuals lifestyle and their ability to participate in healthy activity. I for one will continue to search for a solution, and thank everyone that posts any successes they have had. It gives me hope.
I hope next time I view this site, a physician steps up and offers a suggested check list. For example, how do I rule out heart disease ? or is there a diet that would help to determine if it is hiatus hernia ?
Thanks again.
jpek

[robb]

I see that there have been a few posts since my original posting back in the fall of 2008. Rereading my second post made me laugh a little, thinking that I might be on to a cure by taking the Vitamin B multiple. Needless to say, it did not help. Since 2008 I have been to see a GI specialist ("no, the stomach can't trigger arrhythmias") a cardiologist (put me on Sotolol which helped but I feared the side effects) and currently an electrophysiologist. The EP is definitely the most knowledgable regarding arrhythmia but still doesn't understand the reason that the vagus nerve is getting triggered. He said that treating the vagus nerve with medications has not been very successful. He currently has me on an anti-arrhythmic called Multaq which is one of the better drugs as far as side-effects go, but also isn't very effective in preventing my atrial flutter. There is a great website called afibbers.com which has a wealth of information on atrial fibbrilation and the state of the art in treatment. You have to subscribe to get the current newletters, I think that it runs about $40 or $50 a year. They talk about radio frequency ablation (zapping the 'short circuits' open in the heart that cause AF), but I think the general opinion is try the drugs first then the ablation if necessary. My AF is called paroxysmal, which means the episodes have a beginning and an end and are not caused by any structual isses in the heart. Very interesting that IBS could be setting off the vagus nerve, I will have to review the other symptoms of IBS. I read a case history in the May 2010 newsletter on afibbers.com of a guy who claims that accupunture has cured him. I am also looking into gettng tested on a machine that measures your sympathetic nervous system / parasympathetic nervous system balance. Since the vagus nerve is part of the PNS it makes sense that the tone of the vagus nerve would be high if the PNS was dominant. Ideally the SNS and the PNS should be in balance, from what I have read. This keeps the heart pace in regulation. I will check back again and let you all know if I have had any break-throughs. I wish you all the best.

[robb]

To aechef-

Are you still PAC/PVC-free? It sounds like you weren't really experiencing atrial fibrillation, at least nothing that lasted very long. What other symptoms did you have related to Irritable Bowel Syndrome? I have had some IBS symptoms, but never any pain, which seems to be the most common symptom.

[jpek]

With Westerm MDs not having any answers I tried accupuncture. While accupuncture has helped with issues such as anxiety/stress, the arrhythmia issues contined. There is NO DOUBT in my mind that there is a direct conection to the stomach and arrhythmia. Every 1-3 weeks I am hit with an bout of arrhythmia, and each time, I notice a connection to feeling full in the upper abdomen. Each time I have a bout, I document what I was doing, eating, stress, etc. The last couple of times, grannola bars have been consumed. I will be following up on food alergies. Other than Spicy foods, has anyone else noticed food connections that could be alergy related ?

Thanks,
jpek

[aechef]

Robb,
To address your questions:
I'm not sure if I ever have had a-fib. They had captured some PACs on a holtermonitor, but not some other things that used to occur now and then where it felt like 6-8 PAC's together, without a ventricular contraction (I'd get a little dizzy during those) - these felt like a muscle spasm in my heart, and were usually followed by a loud gurgle in my intestines. Usually I would have to defecate within half an hour of one occurring, so the pieces of the puzzle were coming together. I don't know what those are, but all of this is apparently related to IBS in my case and they never lasted more than a few seconds. Since taking the amitriptyline, the symptoms are radically reduced and I don't think about it much most of the time.

The IBS i have doesn't cause the classic pain symptoms like I normally think of abdominal pain. I would have some minor diahrhea, but also a strange inflamed feeling in my abdomen that woke me up between 2 and 5 every night without fail. The amitriptylene eliminates that strange sensation and I'm able to sleep. I've found that eating a light lunch and dinner works almost as well as the drug, or skipping lunch OR dinner altogether. In other words, lessening the volume in my intestines. I'm very active though, and if I skip too many meals, I lose too much weight. So it's a balance.

The doc said my large intestine has very sharp turns in it, and I required a double dose of the sedative to keep me comfortable. I have come to the conclusion that the large intestine works a little harder in me to get things done, and in the process more impulses go back and forth on the vagus nerve, sometimes causing PACS. so I strive to keep my guts happy thru drugs and diet, and in turn, have cut the PACs and other stuff down to a tolerable level. Interestingly, I noticed when I had many IBS episodes in a row at night, the propensity to have PACs seemed to accumulate over a period of days, as if a set of nerves is becoming fatigued (irritated?), but this has not been a problem since taking ami and paying closer attention to diet.

[robb]

Thanks for the info on your IBS symptoms. I doubt that I have IBS since I have no painful areas, however my digestive system processes food quite quickly but never diarrhea unless I have a bug. I attribute the fast motilation to my dominant parasympathetic nervous system (vagus nerve). Just today I had (and am still having) and Afib episode. I was feeling fine this morning, then I ate lunch and decided to take a short nap on the couch. As soon as I layed down, with my trunk at about 45 degrees to the horizontal, I started to feel the irregular beats. I changed positions and then sat up in a chair for awhile, but it was too late to stop the Afib episode. It has lasted almost 12 hours so far, hopefully I will be back to normal rhythm when I wake up tomorrow. I believe that my vagus nerve sensitivity was high today and laying down with a full stomach put pressure on it and my heart was off to the races. At any rate, I am glad that you have your PACs/PVCs under control with the IBS drug.

Robb

[rick_deckard]

I'm a 26 y.o. male, and I've been experiencing similar symptoms. I'm pretty skinny, generally healthy, good diet. Don't get a lot of exercise. I get heart palpitations, skipped beats, elevated heart rate which all seem directly linked to bloating. I've put together a fairly comprehensive list of my symptoms:

General symptoms:
- acid reflux (fairly mild)
- bloating
- occasional "skipped beat" - Premature Ventricular Complexes?
- elevated heart rate which seems directly related to stomach/abdominal bloating
- heart races when I stand up sometimes, particularly after sleeping
- night sweats sometimes, particularly when other symptoms are exacerbated
- tender/swollen around diaphraghm and bottom-right of rib cage, especially so when bloating & palpitations are present
- reduced exercise tolerance

Symptoms When bloated / after over-eating:
- acid reflux
- more frequent "skipped beats"
- a lot of heart rate variation, sometimes tachycardic
- short of breath
- anxiety
- feeling of uncomfortable, invasive bloating or pressure around diaphragm
- feeling of high blood pressure
- feel a bit lightheaded sometimes
- discomfort & worsened symptoms when lying down, especially palpitations & anxiety
- sleeplessness

Things that cause and/or exacerbate symptoms:
- over-eating
- eating onions or raw garlic
- possibly: spicy food, caffeine, alcohol
- sleep deprivation
- exercise seems to irritate something around the diaphragm

History:
- had increase in symptoms (and some additional ones) on starting dextroamphetamine for ADHD in mid '09. No longer on this medication.
- got ecg & echo, they said heart looked fine.

Notes:
- symptoms increase as bloatedness increases, decrease as bloatedness subsides
- significant relief from burping
- discomfort & anxiety seem directly related to abdominal bloatedness
- bending over causes additional discomfort / pressure around stomach

Possible causes:
- hiatal hernia?
- irritated vagus nerve?
- abdominal cancer?
- hypoglycemia / diabetes?

[rita1963]

The EKG shows the rythum of the heart ...an ecocardiogram will show if there is a problem with the heartvalve..best to see a Cardiologist.

If their is a problem with the vagus nerve--you need to see a Neurologist to see what is causeing the sensativity.
The sensativity can be from many things, like, foods, glucose levels falling (hypoglycemia) etc...