Vagal/Sympathetic Cascade a homegrown theory

[Bagrat]

Apologies as this could get lengthy I am not known for being brief!

Even before I had my first episode of AF in 2011 I used to have a couple of days experiencing nausea, anorexia, chest ache abdominal discomfort even pain and a 'wiped out" feeling . It was investigated more than once and nothing found.I put it down to "nerves".

Since AF diagnosis have had similar every couple of months and add in frequent peeing, more awareness of ectopics and since last year occasional light headedness. In 2020 it happened very frequently ( often 4 days out of seven) and after runs of tachy and lots of ectopics, my flecainide was increasea and everything improved) I can function (mostly) when I get this, but need to rest on bed to feel more comfortable ( it fluctuates, usually evenings better) Lasts 2-3 days with middle day worst.

Sometimes there is an overt trigger, this time a 3 course lunch on a warm day !! I had chosen wisely but..... oh and no alcohol. Sometimes it happens after a busy or stressful few days or before the same. I used to get migraines and that seemed to be the same.

My theory is that this whole caboodle is vagally mediated and then add into the mix my inability, until recently, to listen to my body. Of course include my tendency to health anxiety and the sympathetic nervous system goes into overdrive.

Just wondered if there are alternative theories.

I do try to use meditation, various breathing techniques, hydrate and stimulate parasympathetic ( but no cold! showers!!) Diet not perfect but stay away from highly processed foods

[Tototcx]

I think your question is what do we think about your triggers for getting AF. I was told right at the beginning of my AF journey by the A&E consultant that you can drive yourself mad trying to work out what triggers an episode because the list of triggers is as long as your arm. And I think this is true because I have driven myself mad trying to work out what happens so that I can avoid it ever happening again!

I talked to my cardiologist on Tuesday about this during my ablation (!) because latterly I was getting an AF episode by purely turning onto my left side in bed and apparently anything that can cause stretch in the atrial muscle structure has the propensity to trigger the fibrillation. This hasn't been my only trigger! So start off by thinking that loads of things cause it and I've often said that the perfect storm of issues triggers an event. Anxiety,emotion, high blood pressure bending,turning etc etc. Anything that causes a higher than normal pressure in the atria can set it off.

Hope this helps x

[Bagrat in reply to Tototcx]

Thanks for your good reply. I wasn't really asking a question, more how does it work as a theory anddo others get similar?

[Tototcx in reply to Bagrat]

I think I was trying to say badly,that the theory sounds ok to me. But as the triggers are wide and varied it could be this today and something else tomorrow! I know I've turned myself inside out trying to figure out why. I read somewhere that It can be the sympathetic and parasympathetic nervous systems getting out of sync with each other. But it seems to be this atrial stretch thing that starts of the AF caused by many things. X

[Bagrat in reply to Tototcx]

I totally agree. I've said before trying to find food triggers for example, you end up sucking a grape in the morning qnd spitting it out qt night!!

[Buffafly]

Stomach migraine? I was told children get symptoms of stomach pain and sickness etc rather than headaches. My daughter did and now gets migraine headaches.

Your symptoms sound horrible but not sure about the vagal bit mostly because I don’t know enough about it. I get wiped out every so often but I know it’s simply because my heart can’t keep up with what I want or have to do.

[Bagrat in reply to Buffafly]

Thank you. Yes my son got stomach migraine as a child. I think that's part of my problem. Commit to too much. Never could say no, but getting better (have left it a bit late at 78!!)

[mjames1]

You said: "I used to have a couple of days experiencing nausea, anorexia, chest ache abdominal discomfort even pain and a 'wiped out" feeling . It was investigated more than once and nothing found.I put it down to "nerves".

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Have you seen a GI specialist? Sounds like it might be Relux/GERD, which is often missed by GP's unless you have the classical "heartburn".

Jim

[Bagrat in reply to mjames1]

Thanks for your reply, yes had gastroscopy end of last year -"gastritis and oesophagitis" took PPIs till Feb to good effect as was having night time nausea waking me. Weaned off as suggested by hospital ( didn'twant to take long term anyway.) Take the odd one or 2 rarely now if bad morning nausea. Sleep semi sat up anyway.

[secondtry]

Hi BagratI get the impression you are doing all the right things just haven't gone far enough. You clearly need to progress things eg 2 not 3 course lunch, improve diet more, say 'No' more. I have found you simply have to increase action until you get to level that cuts your individual AF issues. That of course takes months/years and perseverance - I am sure you have both 😀.

[Bagrat in reply to secondtry]

Thankyou secondtry lunch usually small salad or homemade soup so these monthly group lunches ( for which Im one of the organisers) certainly a shock to system. Your advice is just what I need to hear.Frequently!!!

[Ppiman]

Over very many years, I have had a range of "things" that my cardiologist now thinks were brief attacks atrial flutter or AF rather than the anxiety my GP put them down to, but I shall never know. The nausea and chest discomfort you describe was a part of it at times, as was strange dizziness occasionally - weird things, really. What I learned was that the initial cause easily spilt over into much worse symptoms. I eventually came to realise that these were, in part at least, related to increased anxiety and that this can multiply the issues and add to any tachycardia and palpitations. as well as bring on other symptoms. One thing that helped a great deal with this was, before and after my ablation, having various tests on my heart which showed it was in an overall healthy general shape.

Like you, I wondered myself whether all this wasn't somehow related to my vagal nerve. I asked the cardiologist I see for my arrhythmias, and he assured me it was not. He said that vagal irritation was a known but unusual cause of arrhythmia, despite its popularity on the internet and in social media. He went on to explain that it was easily recognisable and involved swings of brady- and tachycardia, among several other bodily effects. Anyway, he convinced me I was wrong.

Steve

[Bagrat in reply to Ppiman]

Thanks Steve Ppiman . I think one of my bad habits is that if I've had a good run of calm I let habits slip, every word of your response makes sense.

[Ppiman in reply to Bagrat]

One of the oddest things I find is that when I’m having a calm period, it’s really hard to remember just how bad it was before.

It’s a strange old illness.

Steve

[Singwell]

Hi - interesting post! I too had similar experiences of feeling odd, wiped out, intermittent vasovagal events around food and heat, also episodes of feeling cold and shivery. No chest pains but sometimes presyncope with the vasovagals. I put it down to subclinical hypothyroidism for the cold and shiveriness (only a hot bath would warm me up), and the bouts of tiredness to what I dubbed 'shingles the return'. I'd had shingles in 2014 and it did return once but intermittently I had these 'warning signs'. The vasovagals I put down to low BP - which previously I had had. (No-one had tracked its more recent progress or informed me from the few times it was checked.) 'Everybody your age has higher BP' my GP informed me when asked!TBH I ignored way too many warning signals - the vasovagals - the bouts of tiredness. Vasovagal wasn't even in my vocabulary although on reflection I'd had what I called 'funny turns' every so often since my 20s and these became more frequent after an acute incident in 2015 (dehydration due to 37 degrees heat in Italy). I didnt realise that these bouts of tiredness were probably lethargy. I was literally days away from an appointment with my GP to discuss my concerns when AF blew up in my face during the floods of 2019 and I was blue lighted to hospital.

Not sure if I'm saying anything helpful here Bagrat other than some of my experiences are similar.

[Bagrat in reply to Singwell]

Singwell It is bizarrely reassuring when you share symptoms with others! The other thing which helps is knowing these episodes are " normal for me"