Chest pain with afib?

[Nanfranz]

I've had paroxysmal afib for a couple of years, which has occurred only rarely. I take 50 mg Flecainde at night and have another 5 mg on hand to use as PIP during the day -- but since switching to this pattern two months ago I have not needed the daytime PIP at all. However, at midnight two nights ago (having taken the nighttime dose) I awoke with mild chest pain which felt like the pain from a hiatal hernia. But my usual few mouthfuls of cold milk did not ease the discomfort as they normally do . Then the afib kicked in, with heart rate up to 140, and it lasted for almost six hours, in spite of my taking another 50 mg flecainide. Having an episode last more than a brief few minutes was something new to me! I spent the rest of the night in a recliner chair and by 6:00 am the afib had stopped. The rest of day was fine. However, today, after a light lunch, the chest pain returned, closely followed by another afib episode, which is continuing now, an hour later. My question is, should I be concerned when chest pain accompanies afib?

[BobD Volunteer]

In general any chest pain especially if it radiated up into the neck or arms MUST be investigated. That says he who has had such pains since new year! I have been to the doctors on two occasions now and tests are ongoing but in my case at least I know it is not cardiac. I know that indigestion and reflux can be really painful but unless you are absolutely sure it is then see a doctor please.

I do know that some people do experience really bad pain during AF events but if this is something new then again talk to your doctor and if it starts to make you feel sick or feel faint or you start to sweat a lot then go to A and E.

[Nanfranz in reply to BobD]

Bob -- thanks so much for your response! It's now two hours laters later and the chest pain has gone, and the afib is slowing down a bit. I should add that the pain was not a heavy crushing type, but more like the pain that comes with hiatal hernia when part of the stomach slips up into the esophagus, along with a burning kind of pain. A bit more than an ache, but not as bad as a heavy pain. Cold milk usually works fast, but these two times it hasn't helped at all. Which made me wonder if this new (for me) combination of several hours of afib accompanied by some pain is simply what everyone else experiences. Anyway, am going to call for an appointment with cardio. Thanks again, Bob!

[Hidden]

This may be your hiatus hernia triggering AF but you need an ECG and blood test to rule out cardiac pain. In your position I would be ringing NHS 111 now for advice, and packing a bag in expectation of an ambulance being sent or advised.

[Nanfranz in reply to Hidden]

Thanks, oyster! My Kardia gadget has been showing "Possible atrial fibrillation" and nothing else. So far, anyway. As soon as I get off this computer I'm going to phone cardiologist.

[Asdfvv]

Perhaps you should drink something other than milk. Milk can irritate and inflame the intestines. What I have learned by now is that our hearts are very sensitive to what we eat. Anything that is not easily digested causes our hearts to work harder. That includes anything with too much proteins.

[Nanfranz in reply to Asdfvv]

Interesting suggestion, Asdfvv -- thank you! For 48 years I've been doing the few-mouthfuls-of-cold-milk routine to calm the occasional chest pain caused by hiatal hernia, and it has given immediate relief each time, so when the pain continued this time I did worry that it was caused by the afib episode that I was experiencing at that time.

[Spoiler]

I know I was told flecainide was only given selectively to people without previous heart attacks, coronary artery disease and some other exclusions. I do not remember what they were. I take flecainide, but was told it is not suited for many with afib as it can increase risks. I have never had chest pain previous to my persistent afib attacks, i have had chest pain with prolonged rapid afib rates of 160-230 (chest discomfort, aching accompanies that for me. ) my afib is persistent once it starts, I require a cardioversion. Any chest pain I would certainly have checked out as soon as possible

[Breezera]

Nanfranz, I'm guessing the mild chest pain you experienced was caused by acid reflux, which is a typical adverse effect of having a hiatal hernia.

Fyi.. I'm 61 years of age and a paroxysmal A-Fib sufferer. I have a small hiatal hernia and have long suffered with reflux (GERD), for which I take a PPI medication. Virtually all of my afib episodes are "vagally mediated" and are triggered by my upper digestive system. Most of my afib episodes are immediately preceded by a period of lower esophageal spasm (likely the lower esophageal sphincter). These symptoms are often accompanied by mild chest pain and feelings of indigestion.

I, along with many others out there as I've discovered, are convinced there is a direct relationship between GERD/upper gastro-system issues and heart palpitations/arrhythmias. The common denominator for this is the vagus nerve. I strongly suggest you google "vagal atrial fibrillation" and see what comes up. Articles written on this topic can be quite the eye opener.

As info.. my current medications are disopyramide (aka Norpace and Rythmodan) 100 mg 3-times daily, apixaban (eliquis) 5 mg twice daily and lansoprazole (prevacid) 15 mg twice daily.

I was taking flecainide for a long while, and previously propafenone, however both of these drugs eventually stopped working for me - I was experiencing A-Fib episodes more and more often despite increases in drug dosage levels. So far - at least in my case - disopyramide seems to be the drug that's best suited to my particular situation (i.e. 100% vagally induced A-Fib).

I'm on the waiting list for a PVI ablation, and it's looking like this will happen sometime in June or July of this year. In the meantime we'll see how things go with my continued use of disopyramide.

Good luck with all, and be sure to carry out as much research as you can. Our doctors and the various specialists we consult with often have a difficult time "connecting the dots".

- Richard (Ontario, Canada)

[Nanfranz in reply to Breezera]

Thanks for your comments, Richard! Like you, I have had many years of hiatal hernia-induced chest pain (when part of the stomach slips up into the esophagus, often causing reflux too), but a few mouthfuls of cold milk have been the unfailing antidote all these years, bringing almost instant relief. So when this time the milk thing didn't work, while at the same time I was having a much longer than usual AF episode, I started to wonder. I really need to invest more time into the subject of vagally-induced A-Fib. My cardiologist has been of little help with any kind of connect-the-dots explanations.

I wish you all the very best with your upcoming ablation! Please be sure to keep us all in the info loop!

I see you're from Ontario. I have many happy memories of three years spent in Windsor, ON -- a lifetime ago.

Frances (in California)