Atrial fibrillation and GORD - link? Just like having a heart attack?

[Ecki]

Advice please.

Hi All, newish to this so it's all a bit scary, sorry it's long winded. I had an episode of atrial flutter 3 years ago, which resolved itself after a night in hospital. They decided it was due to undiagnosed GORD and hiatus hernia. I was put on lanzaprazole 15mg, rivaroxaban and bisoprolol 2.5mg, which went down to 1.25 after about 6 months. Fine on that until late last year. Started to get palpitations and ectopics after a bout of food poisoning. GP took me off bisoprolol, saying it could cause palpitations. Made no difference and after a couple of weeks i was put on slozem (Diltiazem) 180mg. Palpitations and ectopics continued, GP didn't seem too bothered, eventually got a 24 hour ecg which showed some bigeminy, trigeminy, single VEs and SVEs. GP didn't seem too bothered again, but told me I shouldn't be on lanzaprazole long term and to stop it. End of July, had my second ever episode of atrial flutter, taken to A&E, given 2.5 mg of bisoprolol and it resolved. 2 weeks later, another episode of atrial flutter, severe chest pain, taken to A&E, troponin level 870, atrial fib started, they decided i'd had a heart attack. Kept me in for 6 days (due to bank holiday weekend and unbelievable incompetence), because they were sure I'd had a heart attack and would need to be stented. Had angiogram. No blockages so I was discharged with a diagnosis of Atrial fib, which they believed had caused the pain, etc, on 5 mg bisoprolol, 12.5 mg losartin, and a statin (even though cholesterol wasn't high). I was told i would be given an appointment to see an arrhythmia specialist nurse but they are not giving out appointments at present and can't tell me when they will start to give them out.

So here I am at home, still in atrial fibrillation, thinking that if I'd stayed on the lanzaprazole none of this would have happened. Is that a reasonable assumption? Is there a link between gastric system and AF? Has anyone had anything similar? I'd be grateful for any comments or advice or ideas on what I can do to resolve things? Thank you.

[BobD Volunteer]

The vagus nerve is the link between brain. heart, stomach and other organs so yes this is common. PPIs such a lansoprazole are a very bad idea long term as they actually promote reflux so I am with your GP on that one. Strange to find such a well educated GP on this matter as many are not aware of the mechanics. The lower sphincter in the stomach needs an acid environment to open and pass food down to the gut so by stopping the acid you hold the food which makes reflux more likely. Short term, maybe a couple of weeks, is fine but I found this out to my cost years ago.. .

[EngMac in reply to BobD]

google Dr. Sarah Myhill and GERD or GORD. She explains what happens.

[Ppiman in reply to EngMac]

But can I ask what is your recommendation when the acid reflux is persistent and very troublesome; when stopping PPI and attempting control with H2 blockers, antacids and alginate failed to reduce the symptoms? And how do you deal with long-term risks such as Barrett's oesophagus and worse?

Steve

[CDreamer in reply to Ppiman]

I think that is a very good question but I believe that you are between a rock and a hard place continuing with PPI’s.

Have you tried altering you diet? I have some done some study of the connection of GERD with AF and body Biome and come to the conclusion that the origin of these conditions is eating far too much carbohydrates such as bread - which I loved. I stopped eating bread, cereal, pastry, biscuits - anything with flour and sugar and cut out dairy completely for 12 months. I added in drinking apple cider vinegar before meals and then added fermented foods, started the day with kefir but using some fermented food with every meal and take Prebiotics.

If you look back on my posts to 2013-2014 you will see that it was a big problem for me but I haven’t suffered now for many years - until I am away and eat a sandwich or something and almost immediately back to day 1.

I found Dr Myhill’s book an absolute revelation although I wasn’t actually reading it to learn about GERD but it makes so much sense to me and it didn’t make any sense to add another medication if it was controllable through lifestyle changes.

When the pain was unbearable, usually at night, I found liquid Gaviscon followed by sipping warm water really helped.

[Ppiman in reply to CDreamer]

Thanks for your reply. I was replying to BobD’s post also but I do really appreciate your comments and ideas.

My main concern is magnesium absorption which PPIs can interfere with and that can lead to arrhythmias like the flutter that laid me so low from April this year. My peripheral neuropathy has worsened a lot, too - again this can be a link with low magnesium. I had assumed that my electrolyte levels would have been checked but I’ll be asking when I next see my doctor about magnesium, calcium, potassium and vitamin D, all of which PPIs can affect, I gather.

Life with a hiatus hernia and GORD is no fun, and PPI drugs are transformational in terms of quality of life. Certainly, getting older is no fun at times - even 66!

Steve

[CDreamer in reply to Ppiman]

If you need to check your magnesium levels then ask for a red cell count. Serum will maintain magnesium levels at the cost of inter cell magnesium so getting the magnesium into the cells is not easy. Most NHS tests will not cover red cell count unless you pay or unless there is a good enough argument to do it. Personally I cannot take oral magnesium so use a magnesium oil spray which seems to be affective.

Our local hospital trust offers private testing but labs across the country will test via post medichecks.com/magnesium-te... as an example - (I’m not promoting them - just good site to explain a fair amount about Mg).

Dr Myhill writes extensively about Magnesium deficit. drmyhill.co.uk/wiki/Magnesi...

I also follow Dr Sinatra - US cardiologist working at the metabolic level to treat arrhythmias - again good info.

heartmdinstitute.com/heart-...

Hope that helps.

[Ppiman in reply to CDreamer]

I’ll read the links and get back with any questions. Thanks again!

[Ppiman in reply to Ppiman]

Looking at the NHS site, and speaking to my doctor's receptionist, it seems that if my GP specifies "magnesium" it will be a specific test (which will look at potassium and calcium, too - and may Vitamin D). I hope that's right.

[Ppiman]

I had an ablation for atrial flutter in early June but still have various symptoms, including palpitations and chest discomfort under my left rib and sometimes in the sternum area (yet am in sinus rhythm, thankfully). I'm now taking just half a bisoprolol 1.25mg (=0.625mg) tablet daily.

I've also been taking lansoprazole 30mg for years to treat painful acid reflux and a hiatus hernia. I'm having a cardiac stress MRI on Wednesday to check for inflammation from the ablation but I am asking the doctors to look at my hiatus hernia, too, since my symptoms feel much more related to this than to my heart.

I shall be asking my doctor about my magnesium levels, as it seems PPI drugs can reduce these and that can lead to arrrythmias such as flutter but I'm at a loss how to reduce my PPI as the acid symptoms are very troublesome indeed without it.

Steve

[KMRobbo in reply to Ppiman]

Ppi drugs also massively reduce But B12 absorbtion

[Ppiman in reply to KMRobbo]

In a few people, I understand, B12 absorption can be reduced but definitely not in general. Most people on PPI drugs are surely fine, I’m positively assured that anyway by my excellent GP. He said that his major concern for me was that if I didn’t control the acid I risked oesophageal erosion and worse. In the end, I gave up my attempts and went back on 30mg lansoprazole.

I did try really hard to stop taking it. Thus was about two years ago but I came a complete cropper in the process. It took me months to get over nausea and other symptoms the hiatus hernia and reflux caused me while I learned the hard way that Zantac and Gaviscon are utterly ineffective.

For those able to survive healthily without PPI drugs, then I think you should count yourself very lucky. I wish I could join you!

Steve

[healme]

Oh dear. I worry so much about this as I have been on Lansoprazole for 5 years because of a hiatus hernia. I also have AF caused by a leaking mitral valve and regurgitation which caused a stroke 30 months ago. BUT the pain I get from acid reflux is more unbearable than the AF. No help to you I'm afraid but I cannot see a way forward. I avoid triggers but if I miss a dose for any more than an hour it is so uncomfortable. I think we both need good advice. If I get any I will pass it on.

[fairgo45]

I agree with others ,without this drug I cant function normally, after years of reflux it's the only thing that controls it

Huge amounts of antacids are the only option and I've tried many times to stop taking losec but found myself going back on it.

If anyone has any suggestions I'd be glad to be a Guinea pig

[Ppiman in reply to fairgo45]

Apart from having your GP occasionally check for magnesium, calcium, potassium along with vitamins D and B12, I would say hang on in there!

Steve

[Gowers]

Afib/flutter cause me to have indigestion,burning type pain & as others have said it's really horrible & difficult to distinguish between reflux & heart attack. My cardiologist sent me to upper GI specialist last year & I had a mri scan of osophagus/vagal nerve/stomach area which showed up small hietus hernia which I knew about. They told me there is no actual test for vagal nerve but, as Bob mentioned there is def link between it & the heart. I have PPI medication to take as needed but I don't always find them that helpful