Constant Ectopics. How to live.

[Rhiannonimity1]

Hello again.

Recap - I’m 54, female, had PAF for 15 years with episodes down to 3 months apart. I take 200 mg flecainide a day , 5 mg bisprolol and 20 mg omeprazole. My AF always seems to be triggered by a single gastric event which causes severe bloating and pain. The gastric event lasts 1-3 weeks even though the AF is usually resolved in hospital within 24 hours. I had been told that because of my current level of meds, I would not be cardioverted again, so was dreading the next event. I have to say that this far the only time a get AF it is with the gastric event and the only time I get the gastric event is with AF - I have never had one without the other.

Except for now.

I got the gastric event and this time have started with ectopic beats. I have had them for over a week now. My stomach is starting to settle but they are not. The burden is on average 6 ectopics per minute from waking to lunch time. Variable in the afternoon and very light after 6 pm with almost nothing through the night. In the morning it is quite horrible with runs of every second and third beat. I don’t eat until 1pm when I have my main meal. I then have a smaller meal at 6 ish. I don’t eat between meals.

I know this is more a nuisance than anything else - and as such I’m doing my best to try to ignore them and get on with my work. I’m succeeding at that reasonably well. However, they are putting my body into “ fight or flight” mode and I recognise that even though I don’t feel anxious mentally, I’m constantly on the edge of tears and isolating myself. I’m also struggling to eat and only able to sleep for 6 hours a night even though I feel refreshed enough. I’m going to sleep with relaxation recordings every night and practicing abdominal breathing techniques.

Can anybody tell me why this is happening at the moment? And why are the beats so much worse in the morning and better in the evening.

Is there anything else I should be doing?

Thank you.

[meadfoot]

Your ongoing experience mirrors mine exactly and it is hard to live with. The gastric/cardiac connection is a fact for those of us who experience it and many medics accept the connection we are experiencing.

The problem is what can be done about it. My cardiologists hopes gastro medics can help my gastric issues while conversely gastro are hoping cardiology can ease heart issues and one will ease the other but i seem to be getting nowhere in finding a resolution if indeed there is one to be found. It is wearing and disconcerting. I know whenever my digestive system flares then i will be plagued with ectopics, pauses which are the worst thing and then full blown af and SVT will follow.

I loose weight during these flare ups of stomach and heart as eating anything triggers the heart and these flare ups come on average every few weeks, it is so difficult to live with. Once they settle and i can eat without issue i regain my weight. On and on it goes.

Are you on a beta blocker, i was told they could help ectopics. If you find a solution please let us know as will i in response. The vagus nerve is a culprit in all of this i suspect but what to do about it all is the question. Have you looked at Dr Sanjay Gupta video on you tube re ectopics, worth a viewing, good luck.

[Rhiannonimity1 in reply to meadfoot]

Thank you Meadfoot. I’m sorry you are suffering the same sort of thing. I will certainly let you know if I discover anything. I am on 5 mg of a beta blocker and I do watch anything Sanjay Gupta puts out there. I feel in a bit of a downward spiral at the moment. Is it GERD? Is it a small hernia? What is doing this? I was advised not to have an endoscopy as it would put me in AF - so I am clueless. I am waiting for an ablation - which will be next year and my cardiologist says hopefully the ablation will stop the link between my stomach and heart.All the best.

[meadfoot in reply to Rhiannonimity1]

Thank you. I have had a number of endoscopies and had a bravo capsule inserted into my oesophagus for two weeks. Amazingly neither triggered my af although after the bravo was inserted i had af after i had food the next day after the capsule insertion but that could have happened without the insertion.

I have been found to have inflammation and small ulcers at the junction of my oesophagus and stomach found through biopsies during endoscopy, i also have a small hiatus hernia. Under a separate test i was found to have failed peristalsis ie the muscles and nerves in my oesophagus arent working properly propelling liquids and solids forward properly plus GERD. All of these issues are contributing to the stomach/heart issue. I am having a cardiac MRI shortly so will see what this shows heart wise. A recent cardiac CT angiogram showed clear cardiac arteries with no plaque. I hope you find a resolution.

[Ppiman in reply to Rhiannonimity1]

I often wonder whether the culprit might be swallowed air, intestinal gas and possibly a constipated bowel all colluding - along with anxiety - to create muscle spasm in the chest area as well as to push the stomach high up against the diaphragm and for that to press against the apex of the heart. I have been told that that is known to cause ectopic beats which, themselves, can lead in prone individuals to atrial fibrillation. I was told this by a leading cardiologist when I was first examined in my twenties, and he showed me the X-ray to prove it was happening. Since then, however, never has any other doctor who I have seen shown a glimmer of interest in that diagnosis.

Steve

[bantam12]

If they reduce after you have lunch and again after evening meal then maybe having some breakfast would even them out. Not eating from 6pm to 1pm is a long time and you could be a bit hypoglycaemic. Just a thought.

[secondtry]

I have no experience but would it be worth testing what happens with less omeprazole, after your medics approval of course?

[Jetcat]

I feel for ya rhian, I found constant ectopics mentally debilitating to be honest.! I felt every single one of them, at rest, on the move, sitting, standing, etc etc. Have you tried taking magnesium.? It’s not for everyone but it reduced my ectopics massively. It may be worth mentioning it to your cardiologist or gp before trying it of course.

[EngMac]

In a post above this one, I mentioned Dr. Sarah Myhill and GERD. Search for her take on this. She also has theories on gastric issues.

I know for me the nerves in the spine are a big factor. If you can find a chiropractor who does X-rays and believes there are ways to minimize the impact on the heart and stomach, you may get some relief. The drugs you are taking influence the heart and stomach so what a chiropractor achieves may not override this influence. I don’t take any drugs so a change is more evident to me.

Getting off drugs is not easy because the body has to adjust and doctors will usually not help you. Their insurance coverage is a big stumbling block for them. They can negatively affect your health with drugs and that is ok but take you off drugs and a negative happens that is not ok. So you miss the chance that stopping drugs could be a positive. They do change type and dosage but less often eliminate drugs once you are on them. There are likely lots of reasons, one of which is the body now cannot do without them without perhaps a risky adjustment period.

[Rhiannonimity1]

Thanks EngMac. I have always thought there is such a connection between back health and the wellbeing of my stomach /wind/ GERD etc. - this was a good reminder. I will look up that doctor.

[Ppiman]

I have similar, but without the Afib, just the ectopic beats - and not to the degree you are suffering. Mine seem entirely gastric related and last for ages. In fact, this bout has been going on since last December, if not before. I'm just awaiting the results of an echo cardiogram and a two-week heart monitor study. It's a difficult thing to cope with, for sure. I sympathise with you.

Steve