PAF and Hiatus Hernia.

[dizzielizzie1]

I'm new here, but speaking to other people with paroxysmal atrial fibrillation would be great, to share experiences of treatment and tips for coping with PAF. Anyone out there have their PAF triggered by acid reflux caused by a Hiatal Hernia?? My GP is sceptical, but the cardiac doc at the hospital said there was a link.

[meadfoot]

Absolutely. My af episodes are connected with my hiatus hernia no doubt. My ep is convinced. Just wish medicos were more in favour of repairing hernias but they seem unwilling to in the main unless they become strangulated.

[jan-ran]

Hi dizzie, I too have hiatus hernia and I m convinced that gastric discomfort affects afib. The pain of h h is controlled with pantoprazole. But af is certainly triggered sometimes by something amiss in my stomach. All linked to the vagal nerve I understand. JanR

[PeterWh]

Welcome to a place you'd rather not be in!!! You will find loads of support and help.

You will find out and see that many GPs don't know a lot about AF and it's medicines and / or they aren't necessarily up to date. It must be recognised that the electrics of the heart and vascular systems is a new area of medicine with it mainly developing over the last 15 to 20 years and knowledge, understanding and treatment options improving all the time. You don't say what medications you are on nor your age. Has an assessment been done with stroke risk as us AFers are five times more likely to have a stroke than the average person.

[dizzielizzie1 in reply to PeterWh]

Hi PeterWh When I had my first PAF episode my GP put me on bisoprolol which did not stop my irregular heart beat. Two months later I saw a cardiac doctor who put me on Diltiazem. This never stopped it either and so I came off it with my GP's consent Jan 15. I saw him recently and asked if there was something I could take just when I needed it and he gave me 40 mg Sotalol tablets and told me to take one if I needed it. I had an episode last week which lasted 9 hours. I took one tablet when it started but it did not help the irregularity very much! I am 65 and am not sure whether I want to take the NOAC anti-coagulants as they can have serious side effects. Also my GP has discussed the CHAD2 assessment with me and said that he would put my score at 2.5 and thinks that I don't need anti-coagulation yet as I am not a 3!! This surprised me as every other doctor I have seen at the practice has said I should be on anti-coagulation, but this GP is very conservative in his prescribing. I know that AFibbers are more at risk of having a stroke and am beginning to think I should be taking something.

[PeterWh in reply to dizzielizzie1]

Hi Lizzie. A few points in the same order as yours are above. Are you in the UK or the US?

Bisoprolol is only a rate control medicine so it wouldn't stop your irregular heart beat.

If you are in the UK solitol is no longer recommended by NICE for AF sufferers bar a very few exceptions. I understood that it should be a cardiologist who decided following some tests. However some GPs still prescribe.

Won't go into the pros and cons of NOACs v Warfarin as there have been loads of posts on this. My comment is that in the last 2 or 3 years opinions of EPs and cardiologists have shifted significantly in favour of NOACs. However some medics are still dead against then and some almost will only prescribe them and not warfarin.

Not sure where your GP gets 2.5 from because that is not an official score. However if it is 2.5 then you SHOULD be anticoagulated because the threshold is 2 !!!!

Unfortunately not all GPs are up to date on AF, anticoagulation, etc because often the specialists, etc who are around now did not exist when they did their training and things have changed quite a bit in the last few years.

Which ever route there is no guarantee!!!!

[dizzielizzie1 in reply to PeterWh]

Thanks Peter--Think it's time I gave serious consideration to starting on a NOAC.

[Hidden]

G'day dizzie lizzie,

You are shifting into a little known area. There is a nerve in the central nervous system called the vagal or vagus nerve. In plain English, the 'wandering' nerve. Do suggest you 'Google 'it and familiarise yourself, then 'Google ' Vagal nerve diagram and you will see the extent to which this nerve influences the performance of various parts of the body. Its pretty awesome.

It is a nerve which, in a sense, CONTROLS the heart and the digestive system !

So what I'm saying if you have a condition that sets off digestive issues then I have the view there is a pretty good chance the vagal nerve will pick up on these digestive issues and transport them along its 'information super highway' to the electrical system of the heart ( and maybe other places too). Thus linking both digestive issues and heart issues.

Now I do stress, that the vagal nerve is but one of many scenarios that makes its contribution in some people to the wider AF scene. I think one of the problems with modern western medicine is the hell bent desire to compartmentalise/specialise various parts of the body rather than take a more holistic approach. Its only more recently the Cardiac Consultants have begun to acknowledge the vagal nerve whereas Gastro Consultants have acknowledged it for ages.

As part of the learning curve it would be interesting for you to go onto YouTube and search for York Cardiology and view some of the videos on there. I think, from memory, there is one about the vagal nerve etc.

I identified food as a major trigger in my PAF about 4 to 6 months after being diagnosed, for no other reason than I developed symptoms in the digestive system similar to IBS and Coeliac Disease - once these had been eliminated I consulted a Nutritionist who advised on a diet process and whilst this took some years to master the end result is I have now been AF free (never said cured !) since April 2015 - with no surgical intervention, just meds and diet.

All of this of course is absolutely no help to your hernia issues but hopefully might enable you to grasp a wider picture.

May the force be with you.

John

[Denise- in reply to Hidden]

Thankyou John that really helped me too

[LindaDaisy in reply to Hidden]

I'm just beginning to find out about this nerve. Following a ear/throat infection, I developed bells? palsy on my face and after pushing the doctors both cardiac and neurology now admit I possibly have vagal nerve damage. This has triggered a AF episode which has been going on for several days and is unlike any other I've had before. I'm fine if I sit still but any activity sends it up to 100 - 140. They are trying to get the rate down by drugs. Feeling rather scared as my throat and ear are hurting again and my throat now has white spots. I also have acid reflux and can have trouble holding on to urine sometimes, which reading up on are also signs of nerve damage.

[ted21 in reply to Hidden]

What is the diet? It sounds like a good idea to me

[Hidden in reply to ted21]

Hi ted21,

It was a long process, and to a degree is still a 'work in process'. I have (self) trained myself to be aware of foods that might upset me. I work on the basis that a calm vagal nerve, and a feeling of 'lightness' in my chest and gut area equals no AF.

The Nutritionist firstly put me on a course of Probiotics ( 450 billion bacteria per sachet). The purpose here was to stablise/clean up my gut flora. She added to this the diet - I suppose the word diet is incorrect as it was not a diet in a weight loss sense, probably a "food intake programme" - lets call it my FIP - is a better description.

Firstly she suggested I go Gluten and Wheat free. She also advised me to consider the FODMAPS diet. (I do suggest you Google this). FODMAPS is quite a discipline and I just picked bits and pieces from it to suit me. Despite going Gluten and wheat free it wasn't the total solution and so I disciplined myself to be aware of other foods that create a state of dis-ease with my vagal nerve. Let me say if I stuck to the 'health mantra' of eating 5 or 7 fruit and veg a day I'd be a total, abject, permanent AF cot case. For me it just doesn't work. Nowadays, so long as I remain with this state of "lightness" I can say, honestly, I'll remain AF free, and I have confirmed my FIP is working.

Some stuff I have eliminated - anything with wheat, gluten and oats; also, yoghurt, raspberries, processed meats, pork, Yorkshire pudding, gravy, lettuce, tomato, onion, Chinese meals generally but I have identified some that work well for me. I have cut back red meat but not eliminated it totally. That's a start. Frankly, part of the discipline is to check the ingredients on any foods I buy.

In February 2014 I had my regular eyesight test and the Optometrist found (from an eye photograph of the back of the eye) my blood sugar levels were very high and felt there was a possibility I might be borderline diabetic. This gave me a massive fright as my father died from diabetes. My GP carried out Hba1c blood tests and confirmed my blood sugar WAS INDEED very high, not quite pre diabetic. I went into crash mode and cut out all added sugar from my diet and cut out other fruits too. This did the trick and my blood sugar readings dropped dramatically and nowadays I have an Hba1c reading of around 35. Not brilliant but safe enough ........ and of course helps keeping the VN calm.

Hope this is of interest to you and to others who may read this.

John

[NooNoo14 in reply to Hidden]

Hear hear Carneuny. Your summary of PAF being possibly triggered by the vagal nerve is spot on.

I was also diagnosed with a HH at about the same time as having PAF (although I had suffered many bouts of PAF in the 3 years before diagnosis). Fortunately my EP / heart consultant was in total agreement with the VN link.

I lost the HH symptoms by losing weight. I also try not to eat my evening meal after 7pm and avoid anything that is hard to digest (e.g. red meat, lots of potatoes). I do not drink caffeinated drinks or alcohol. Not wearing clothes that are tight around your waist / midriff also helps.

I am on Warfarin, Diltiazem and Flecainide and although I hate taking meds, they have been keeping the PAF under control for some time. I did have an episode a couple of weeks ago but suspect this was caused by drugs that were administered during a procedure on my eye but I need to run this by the doc when I have the next one done in a couple of weeks time.

I am not claiming that what I do is a cure all for everyone with PAF but it may be something people can try and you never know.....

Netty

[dizzielizzie1 in reply to Hidden]

Thanks John, I really think there is something to this Vagal Nerve thing as a cause of PAF. Not sure my GP will agree though. He is very conservative in his thinking.

[Lcpatrol]

I agree with all the above replies. I too have an HH which has triggered AF. My AF is controlled with bisoprolol and Flecanaide but I often wonder whether I could do without them if I managed my HH better. At the moment I keep taking the meds because I don't want the AF to return.

I think the biggest thing to avoid with an HH is large meals and or spicy meals. Best eat little and often. I also find massaging my HH just below my rib cage in a downward movement useful.

And yes you'll be lucky to come across a medic who agrees with the association between the stomach, heart and vagus nerve; they assume you suffer from nerves and will try to prescribe drugs for depression or anxiety.

[PALady]

I have PAF and had my longest ever episode recently. It coincided with symptoms similar to IBS and I mentioned this to my cardiologist, who said there could well be a link. As soon as the PAF episode ended (of its own accord) the IBS type symptoms stopped. I don't as far as I know have hiatus hernia, but I have been conscious that my heart rate gets a bit bumpy if I have spells of acid reflux and bloating. Equally, frequent trips to the loo (of both types) are a sign of a 'big' episode for me, so I have absolutely no doubt of the strong link between and unhappy digestive system and an unhappy heart. I have also noticed that rushing meals is not good for my tummy or my heart, so I do try to eat more slowly.

[dizzielizzie1]

Hi PALady-- I have decided to try and cut out foods on the Fodmap list. It won't be easy, but if it will help my IBS and Hiatus Hernia, and ultimately help reduce the number of PAF episodes I have, it will be worthwhile.

[PALady in reply to dizzielizzie1]

Good luck Dizzielizzie -I hope it works for you.

[dizzielizzie1 in reply to PALady]

Hi PALady--- Will let you know how I get on , it's quite restrictive, but I'm going to try and stick to it.