More on GERD

Today Mike F. posted links to abstracts on two articles under the topic GERD and AF. It’s amazing how unusual threads on this BB pop up exactly when someone else is contemplating that very topic. And so this one was for me.

I’ve been thinking a lot about GERD and the vagus nerve. We’ve recently debated exactly how this triggers AF.

One of the articles Hans cited in the CR under “The Play”, was one by Miyamoto et al., entitled “Effects of Right Lateral Decubitus Position on Plasma Norepinephrine and Plasma ANP Levels in Patients with Chronic CHF”. I copied it from the hospital medical library and I don’t think it’s available on the internet anywhere. However, the main point of the article is that, when lying on the right side, sympathetic tone decreases and parasympathetic tone increases. This was demonstrated via NE levels, which decreased and HRV measurement, which increased. In other words lying on your right is supposed to be vagotonic.

So why do so many LAFers repeatedly state that lying on the left side can often trigger an episode? I find this contradiction rather curious. I think it is important to remind you that the stomach is located in the left upper quadrant. The gastric outlet to the duodenum is to the patient’s right. Therefore lying on one’s left side retards gastric emptying. I’ve always told my kids when they complain of a stomachache to just lie on their right side. Could it be that lying on the left side causes some gastric distention and consequent vagal stimulation? There would have to be significant vagal stimulation from the left lateral decubitus position to drive us to prefer lying on the right side, which has been shown to increase HRV and decrease NE. It seems that this preference for the right side is not limited to those with known GERD.

On 3/9/03 I submitted a post on RSA and the swallow reflex.
[www.afibbers.org]
In it I referenced an unusual anecdotal story about a 38 year old with AF triggered by swallowing. [www.medhelp.org]
This is very similar to the patient in one of the articles Mike referenced in his earlier post today. In that patient swallowing triggered simultaneous gastroesophageal reflux and paroxysmal AF. In the other article it was shown that patients with diffuse esophageal spasm experienced significantly more intense bradycardia during swallowing than normals and it didn’t even mention GERD.

It appears to me that LAF may be triggered in many with esophageal dysmotility who have no evidence whatsoever of GERD. Perhaps AF triggered by the left lateral decubitus position is a provocative test for subclinical GERD. Perhaps actual gastroesophageal irritation and inflammation is unnecessary. Triggering AF may simply be due to crossover stimulation of vagal fibers to the SA node resulting in bradycardia via a mechanism similar to that for swallowing, something that plagued me for months.

This particular trigger for AF seemed to pass after I started drinking waller water and has never returned once I commenced aggressive magnesium supplemention.

PC v54

PC,

I haven't noticed any preference or problem with lying on either side now, but strangely my wife cannot go to sleep on her left side, because her heart pounds so hard, when doing so. She doesn't have any digestive problems, that she knows of, and this happens every night, without fail.

When I was on beta blockers, it was a different story, however. Lying on my left side could precipitate AF, and also made me think I was vagal, when I now know I am mixed.

Richard

PC,

I might add that my wife smokes. This sounds like an adrenalin issue to me.

Richard

During the time when I was prone to LAF and before I undertook magnesium supplementation, I found that lying on my left side would induce afib. Most of the time when I did this, I quickly got up from bed and the afib would remit within a minute or two.

These days, still with my magnesium supplementation, I find that lying on my left side can induce tachycardia with very strong contractions, which invariably wakes me. I no longer can induce LAF lying on my left side.

PC,

I was thinking about why a deficiency of molybdenum is linked to esophageal cancer. Any thoughts come to mind?

Richard

PC,

I'm pleased that the 2 articles I proffered both peaked your interest and dovetailed in nicely with your current line of investigative thinking re esphagal dysmotility and AF.

I came across the 2 said articles whilst engaged in medhelp site searches using various key words including esophagal dysmotility, dysphagia, atrial fibrillation etc. further to reading some threads from another AF forum which can be viewed at:

[www.med-edu.com]

to which there are numerous posts arguing the connection between GERD and AF.......... in fact FAR too many for there to be nothing to it. I have ALWAYS believed in the oft-purported by AFers but equally oft-denied by cardiologists connection between upper digestive tract problems and AF. After all, the nerves to the heart and the digestive system are inextricably linked in many ways - both obvious and more subtle.

I personally have a long history of diagnosed GERD and gastritis. In 1987-88 I had a HORRIBLE time of it with BAD BAD reflux REALLY excrutiatingly painful heartburn, food-stuck-in-throat, belching food back up etc. etc. Twelve months of cimetidine helped put matters back on a more tolerable footing. However, I've been plagued with problems - albeit not so sever - on and off ever since. The paleo diet has, however, helped enormously. No more need for a packet or 2 of tums every day. My GERD probs precipitated a lot of ectopy which I've had ever since.

Of particular note, on the 2 days AFTER my most recent AF episode (2.9 hrs self-converting 3.20am kick-off whilst in bed, following large late lamb tagine meal and a bottle plus of good red), I had quite unpleasant esophagal spasms which lasted from about 6-7 pm on both days. It felt like my esophagus was contracting painfully for some 5 to 10 secs before relaxing for 30-40 secs with the pattern then repeating. (I have experienced similar episodes of unpleasant esophagal contractions perhaps a dozen times during the last 5 years........... mmmm..... thinking as I write...... about the same period of time during which I've had 4 episodes of AF........)

Lots of food for thought here for sure. Keep up the great work PC, and I'll have a further rummage for some more articles when I get chance.

Mike F.

I do suffer with disgestive problems now and again. Also i had a very bad bout of Gastroenteritius 2 and half years ago.

My GP always called my problem mild case of IBS and knew i was sensable enought to sort my diet out myself. Except a couple of times when i needed something desperately to help me (thats when i was doubled up with pain). I also suffer with that swallowing problem, when it feels as if something is stuck in the throat and can only eat a little at a time inbetween having a drink.

I have noticed recently when i have that high up pain near the disgestive tract, feels like server indegestion goes now when i take Asilon from my GP.

I've always thought there was a connection to AF well it all has to travel somewhere in the system.

Babs

I've always had a problem lying on my back. I keep of my sides incase I roll over and make sure I go to sleep on my stomach. If I lay on my back my heart used to race and race and wake me up with night terrors, now this does not happen so much but my heart seems stronger and louder. When I used to see Cardios the one question I was always asked was if I had problems with my stomach. My answer was always no. I might be one of the silent ones. But my curiosity is now tweaked. My uterus tips the wrong way. This has always caused me long excruciating labour problems (18, 20 and 26 hours full pelt) as the head does not engage properly - and my AF was more severe during pregnancy than any other time. Is it possible that the uterus tips onto the vagus nerve in my case?

Fran

Richard,

I have no idea on the molybdenum question.

PC

There is absolutely no doubt in my mind as to the connection. Sometimes, I can have a little gastronomical distress without going into afib, but I never, ever have afib without accompanying gastronomical distress. It kind of feels like a burning in my esphogal area. It cannot be coincidence!

As to the sleeping question, I have a tendency to have a stiff neck and lowe back. Usually, I fall asleep on my back, with my head on one of those temperpedic type pillows. I try really, really hard never to sleep on my left side, although I have never noticed that it causes afib for me. I do sometimes note a heightened awareness of my heart beats though, when laying on my back. I guess sleep posture isn't an issue with me.

PC
Would't proof of the link between GERD and afib be established if you had a pH study test and a Holter monitor test at the same time over the same 24hr period?

See my posting and answer to Fran :pH study &holter test together" 10-13-03.

Dean

Dean,

GERD is more than just a pH pHenomenon. There is incompetency of the LES (lower esophageal sphincter), allowing gastric contents to reflux into the lower esophagus. Perhaps adding manometric measurement to your recommendation would underscore the affiliation. In fact the abstract to the second article Mike F. linked recommends this very combination - pH, manometry and EKG - simultaneously.

[www.ncbi.nlm.nih.gov]

PC

In my best Arnold immitation:

let me tell you something, I know that GERD and just plain acid and gas causes palpitations and maybe my lone afib like I know pumping iron can get you into movies.

I tell you this, I went to the ER thinking I was going to finally die cause my ticker was bouncing around faster than democratic candidates opinions on the Iraq war. 185 BPM happens normally only when I am pumping iron or alone with Maria, I tell you this seriously. Listen to me know and hear me later. And the beat was not like a steady rap beat..no..no, but more like that crazy Rush beat that I like so much. bap, bap, balp ......bapbap....bapbapabp............bap. You know like an ak47 on auto or whatnot and something like this (these are outlawed in the great state of caleeeforneea.

I was thinking for a time it might be better to croke than to put up with all the funny rhythms I have had over the years - I felt like Gray Davis on recall day I tell you. I made my concession speach to the man in the sky I tell you.

And let me tell you something else that will amaze you more than Terminator VI, I was still in afib when I got home with a lower pulse. I took a pepcid AC and within 2 minutes my pulse was as steady as a rock. I am not kidding you now so hear me now.

And you talk about VAGAL and lying on your left side and drinking the cold drinks from the 7-elevens or the sonics..let me tell you, my afib came right after hitting the extra-large cherry brain freeze which was colder than Maria was on our wedding night I tell you. And things like this when on my left side having the same jumpy rhythm only it would go away when I moved. Sometimes on the right side but not as bad - maybe i need to pump more iron on th left side, I do not know these things and other things like that.

I will tell you I am a nervous depressed wreck most of the time because I am a girly man who needs to work out more and talk less. Listen, I am here to pump you up! I could also use some pumping up if you veterans have some more advice. I want to get some of this funny water you have been talking about with the magnisium an pehaps some ther metals like in terminator.

God bless you all ,

Tom