Afib: The stomach-heart connection

hi guys my name is Sanjay Gupta I am a consultant cardiologist in York and today I wanted to do a little video on the subject of hatred fibrillation entitled atrial fibrillation the heart stomach connection okay now as a result of my videos I often get the opportunity to talk to hundreds of people who suffer from palpitations and most people I speak to either have a topic heart beats or be atrial fibrillation okay now when I talk to people who have a topic heart beats the two commonest triggers that I get to hear about are number one anxiety by far and away the Communists but secondly a lot of people say to me when my stomach is bad when I've got reflux when I've got indigestion that's when I get mic topics and then I also talk to a lot of people who have atrial fibrillation particularly those people who have atrial fibrillation which comes and goes I paroxysmal atrial fibrillation and in those people when you ask them what are your triggers what are the triggers that make your atrial fibrillation come on and the majority of them will say one of four things okay sleep exercise number three stomach issues again eating after eating when I'm bloated when of getting reflux and fourthly alcohol okay so it becomes very interesting as to it's very interesting to me that so many people describe issues with their stomach as a trigger for both PVCs ectopic heartbeats and atrial fibrillation and therefore by far one of the commonest questions I get from patients is why do I get my palpitations when my stomach is bloated or when I have indigestion or when I have reflux is there a connection okay so I thought I'd go and explore the connection between the stomach and the heart because it's not really well described a lot of people go to see their doctors and the doctors say well I don't think there's any relationship at all and that's because there's not really much information out there about this so I thought and I'd go and do a little journey and try and explore what the connection may be okay so the first thing to understand is that both reflux disease and atrial fibrillation are extremely common okay one to two percent of the population have atrial fibrillation and as you get older the incidence of atrial fibrillation increases now gastric reflux GERD or gastroesophageal reflux disease is extremely common extremely common in the Western world 20 to 40 percent of the population in the Western world experience reflux at least once a month and up to 10 percent of patients experience reflux on it at least once a week okay so it may just be one possible one possibility is that AF is common reflux is common and therefore it's not surprising that they occur in the same patient all right and sometimes at the same time so that's one possibility however it's also worth knowing that many of the factors that cause atrial fibrillation or predispose patients to atrial fibrillation also predispose patients to having gastroesophageal reflux disease GERD okay so obesity obesity is a risk factor for atrial fibrillation and obesity causes GERD sleep apnea causes afib and causes GERD diabetes causes reflux causes Girt and age increasing age will cause reflux and will cause will cause AF and will cause GERD so it can be quite difficult to know whether the reflux actually causes atrial fibrillation or whether they simply coexist because they share the same parents ie age obesity sleep apnea diabetes etc so that's another thing just to be aware of in an ideal world if you want to prove as to whether there's a causative relationship between a fib and between reflux and afib what you ideally want is a good study to confirm that relationship so I wanted to see if there were any large-scale studies that have been done which test the idea that reflux could cause a fib making in an ideal world what you want is a large study with lots of patients patients who have reflux and who have afib where you want to study them by giving them either medications to treat their reflux or a placebo and measuring which group has less AF as a consequence that's what you really need right but unfortunately there are no such studies and there are no such studies because they haven't been done um so I couldn't find any single study but that doesn't necessarily mean that there is that there is no link just because a study hasn't been done doesn't mean just because you haven't confirmed the the Association or the causative relationship by a big study doesn't mean that there is no causative relationship simply because if the study hasn't been done how can you be sure so I thought I'd decide I decided to look a little bit more in more so smaller studies I delved deeper into the literature to try and find out if there was anything that could help us understand this connection between the stomach and the heart okay so there was firstly a very interesting study by a guy called Kunz okay and I'll if you come to my Facebook page I can put these links up all right so Koons did a retrospective study where he looked at about a hundred and sixty thousand patients okay and he went through their medical records and he found that five percent of these patients suffer from atrial fibrillation and actually 30 percent of these patients had dared okay and what he found was that people who had gastrous offered real reflux disease or GERD had a 40 percent increased chance of having afib but this is a retrospective observational study so you can't be absolutely sure but it does point to an association that people who have reflux disease seem to have more atrial fibrillation now you may say well yeah but they may they share the same parent so when he adjusted for common comorbidities he still found that there was a relationship between reflux disease and HL fibrillation meaning people who had reflux disease had more atrial fibrillation that people who did not have reflux disease okay so then you have to say okay well that's interesting is are there any studies which have shown that if you treat reflux the afib gets better and there are so there was a very interesting study by a chap called regal again I'll try and put the links up on my Facebook page who found that when 18 patients who had lone afib where the afib came and went okay so paroxysmal own afib when they were they were given acid suppression therapy for their reflux proton pump inhibitors for two months 78% of those patients found that they their afib got better so they had less symptoms from their afib so that's interesting the second study was very interesting as well and this was by a chap called Gerson and basically he only studied three patients but what he did is he measured the pH in their esophagus so when you have reflux you know you the pH is low and what he found was that when the pH is low patients get more afib when you treat the pH by giving them acid suppression therapy they got less afib or their symptoms from their etiquette got lot better so that was again another interesting study and I did find lots of case reports where people who had big hiatus hernias okay in hiatus hernias often cause you know it's basically a little bit of stomach that is herniated into the esophagus so they do get a lot of reflux when you treated them or when you operate the hiatus hernia the afib got better so there are lots of little pointers which suggests that maybe there is a causative relationship between reflux disease and atrial fibrillation and actually treating the reflux disease seems to get the atrial fibrillation better but as I say you have to take these data whether with a little bit of skepticism simply because they're not like large-scale properly controlled studies but they do point to an association certainly and probably a causative association okay so overall I would say that there does appear to be a definite connection between the stomach and the heart okay and so then you have to say well what are the likely mechanisms why is there this relationship okay the heart is the heart the stomach is the heart what's the relationship the first thing to say is that the software guess the food pipe sits really really close to the left atrium making I do these things called transesophageal echocardiogram and I actually have to look when I want a good picture of the left atrium I put a camera down the food pipe the esophagus to look at the left atrium and the relation the distance between the food pipe and the left atrium is only about four or five millimeters okay so they're extremely close together and it is quite likely that when you have inflammation of the esophagus you could also potentially irritate the left atrium and that is one mechanism by which it could trigger atrial fibrillation okay the second thing to say is that inflammation by itself is a very Pro rhythmic condition so any form of inflammation within the body is more likely to cause atrial fibrillation okay if I develop a toe infection if I develop a chest infection if I develop you know if I develop the urinary infection I'm much more likely to have atrial fibrillation than if I don't so just because other I know that I've mentioned the local effect but also just because of inflammation because when you have part of your soft focus which is being burned by acid then that is very inflammatory and that will release inflammatory cytokines you know Pro inflammatory mediators into the body and those can irritate the heart and that is why people could develop a topics and also atrial fibrillation the third thing to say is that in those people who have things like hiatus hernias you may have a compressive effect to the hiatus hernia could actually bulge and compress on the left atrium and that could also be another mechanism by which you could trigger both tech topics and atrial fibrillation and finally and probably the most likely mechanism is that the acid in the stomach activates the vagus nerve okay and when you activate the vagus lab you can't wriggle trigger what is known as vagal AF and well I'll do a video on vagal AF hopefully in the next couple of weeks or so but if you want to understand a little bit about the vagus nerve please feel free to watch one of my videos I think I've done a video on the vagus nerve and I've also done a video on the gastric cardiac syndrome so if you get a chance to watch it so those are the various mechanisms by which the stomach and the heart are connected from what I have read it definitely seems like there's a very solid connection between the stomach and the heart and it does seem that a people with reflux get more a fib be treating the reflux seems to get the a fit better the problem is the treatment for reflux is usually PPIs and the problem with ppi is is that they have other sorts of side effects such as because you're taking a PPI you're suppressing all acid production and therefore you don't absorb some of the other important nutrients like magnesium and that is why one of the best ways one of the best ways to get this better is weight loss if you can lose weight if you can improve your sleep if you can improve your diet if you can get regular exercise your reflux will get better and with that your afib will also get better so as always you know my recommendations are always lifestyle first but if lifestyle is working for you then a trial of proton pump inhibitor therapy may help if you have reflux disease so I hope this was helpful please do keep your comments coming I really appreciate them I really appreciate all the lovely words I read everything so thank you so much thank you so much for all your support I really really appreciate it and I look forward to talking to you again in the near future just to let you know if you need to talk to me you can do so through my website which is www.hyken.com do Logie at gmail.com that should take you to my facebook page if you go to facebook and just type your cardiology at gmail.com you should find me and you know I try and be I try to be as interactive as possible but my workload sometimes doesn't allow me but rest assured I will try and get around to answering everyone into your course thank you so much all the best take care bye

Channel: York Cardiology

Views: 160,352

Keywords: iMovie, heart, gastrocardiac syndrome, roemheld syndrome, palpitations, GERD, reflux, indigestion, heartburn, afib, atrial firillation, yorkcardiology, sanjay gupta, Dr Sanjay Gupta, heart disease, heart palpitation

Id: bwgDFHOkR20

Length: 14min 34sec (874 seconds)

Published: Wed Jan 25 2017