Palpitations and the vagus nerve

hi guys my name is Sandra hooked I'm a cardiologist in New York and tonight I was keen to do a video and I put it out to you guys as to what you wanted to hear about and particularly Julie Julie wanted to know a little bit about the vagus nerve and how the vagus nerve can affect the heart and how it can be responsible for ectopic beats so this is quite a complex subject and I wanted to do it in a simplistic way so I have to do a little bit of research so bear with me because it's quite tough to explain all right so the first thing to realize is that if you take the heart out of the body okay it will keep beating okay now it beats according to a rate that is set in the inner part of the heart called the pacemaker the sinoatrial node or the pacemaker and the pacemaker is just programmed to beat at a certain rate all right so the pacemaker you can think of the pacemaker as a as a as a drummer okay and he's meant to fire at a certain rate all right and so if you take the heart out of the body completely on its own you know there's no connection to the heart the heart will continue to beat for a little while alright and the rate of the heart is decided by the pacemaker the pacemaker sits there he fires he fell or he hits a drum the heart beats then he waits he hits a drum and hit the heartbeats alright now it is also important to know that he is not the only drummer in the heart but his drum stops all the other drummers from beating ie there are other areas in the atrium or in the ventricles that also fire all right but because the pacemaker is firing at a certain rate it is overriding any other areas from firing all right so but if you slow the pacemaker down excessively then other areas may choose to fire instead all right so it works because it is firing at a certain rate and because that rate is higher and then a certain level it suppresses are the bits of the heart from firing now so that's what happens to the heart when it is out of the body however when the heart is in the body the body needs some kind of mechanism to control the heart rate you can't just rely on the heart beating at a certain rate all the time because there are times when you need the heart to beat faster there are times when you need the heart to settle down after it's beating for after it's been beating faster and therefore you have innovation of the heart by something called the autonomic nervous system all right and so the autonomic nervous system consists of two parts there's the sympathetic nervous system and the parasympathetic nervous system the role of the sympathetic nervous system is to increase the heart rate alright so that is done by secreting adrenaline and noradrenaline around where the heart is and that adrenalin that is released by the sympathetic nervous system speeds the heart up it will also make the heart more irritable if the heart has an irritability about it speeding the heart by the sympathetic nervous system will increase the irritability and that is why what happens when you get anxious or when you are for example watching a scary movie or you know someone jumps out at you what happens is that your sympathetic nervous system starts acting very yeah starts is is activated you'll release adrenaline and that adrenaline acts on your heart and increases your heart rate so the first thing to say is the sympathetic overactivity okay like the flight of right response will increase your heart rate in general when you so it is often the case that people will get palpitations when some the sympathetic activities increase all right so the palpitations can just be a fast heart rate that you notice a lot more or it can also be more in the way of a topics or sometimes heart rhythm disturbances like you know SVT's etc atrial fibrillation can also happen as a result of a sympathetic overactivity excessive sympathetic over activity the one of the hallmarks of sympathetic over activity is the fact that generally if the heart is just going faster I you are developing a sinus tachycardia the heart rate tends to go up gradually and come down gradually if it's a distributor or a heart rhythm disturbance the heart rate goes bang up stays at a certain level and then bang like a light switch it comes off alright that's sympathetic and activity now anything that activates the sympathetic nervous system will increase your heart rate but on the other side you have the parasympathetic system which has the which has the effect of lowering the heart rate so it does everything in opposition to the sympathetic nervous system and the vagus nerve is a nerve which essentially provides a connection between the brain the heart the lungs and the gastrointestinal tract and basically this releases something called acetylcholine and the effect of the vagus nerve is to slow the heart down and it is quite important for the vagus nerve to act because if you for example have sympathetic over activity what brings your heart down back to normal so say someone scares you you don't want your heart to just continue beating it beats per minute what tends to happen is that the sympathetic activity starts dying down and the parasympathetic activity goes up and that brings your heart back down now in some people so the vagus nerve is responsible for parasympathetic activity I slowing the heart down all right now in some people for example athletes what can happen is because they're training themselves to such a level they're constantly if they're parasympathetic nervous system is very active okay and it tends to predominate and their heart rate tends to go very low now the problem with that is that if you're pushing the heart rate very low then you're basically asking that drummer in your pacemaker to slow down excessively which means that there are other areas in the heart and the atria that can then start firing so it is quite possible that they go stimulation or excessive vagal activity will increase your propensity to developing a topics or PA sees premature atrial complexes because you're basically slowed the pacemaker down the only reason you're not getting them you're not getting PA ceases because the pacemaker is beating at a certain rate but if you slow the pacemaker down then other areas around the atria can then start firing and they come through and back and then cause P ACS and PVCs and PA C's mainly and that's why a lot of athletes often develop things like atrial fibrillation or prepa or paroxysmal atrial fibrillation because their vehicle tone is so high their heart rate goes below that level where it can override any other areas which could release complex air release impulses now one of the very relevant things about this is that generally if you have heart disease or if you have a structurally abnormal heart it's more likely that you're going to get sympathetic media PBC's PA CS etcetera and if you have a structurally completely normal heart it is more likely that you're going to get parasympathetic limb mediated PA sees eye your overactive parasympathetic nervous system pushes the heart rate below its baseline at certain times and can do it one of the interesting applications of this is them is with gastroesophageal disease or gastric distension so what happens in there this is called the room held syndrome our OEM hgl d Run syndrome and basically what happens is that the star gets distended the vagus nerve which is going which is traversing around the stomach can get compressed and bile is compressing it you can actually cause the parasympathetic activation and then that can actually push the heart down even lower and that can been caused PA ceased to develop and that's why um people find that after eating they can get this and the answer to that then is to try and try to avoid eating big meals and try avoiding carbonated drinks because they can't really stretch the stomach and so if you have small meals then that is less likely to cause PA CS and PVCs after food another thing to be aware of is that the vagus actually you can actually press on the vagus hear vagal stimulation so if you compress here and you rub it that is activating your vase vagus nerve and we often use that in people who have say supraventricular tachycardias where we think that the SVT has been caused by an over activity of the sympathetic nervous system so by compressing their you can slow the heart down so pressing over here has the ability to slow the heart down and abort ectopic sore abort dysrhythmias caused by an over activity of the parasympathetic nervous system um so that's about it really I think it's just where it's just good to be aware of the vagus nerve it's worth knowing that it traverses here so basically what you do is you feel for this Adam's apple here and then just slide your hand down there and press on that I wouldn't recommend you do it you know to yourself and certainly you shouldn't do it on both sides because you'll end up constricting the blood supply to your neck but it's just worth knowing that's over there and sometimes just by pressing there you can actually get rid of svt's these are called vagal maneuvers other vagal maneuvers can be things like rubbing your eyeballs or or putting your head in cold water and for some people if you have sympathetic overdrive causing your arrhythmia or disrude near then vagal maneuvers can help if on the other hand you have a predominantly parasympathetic reason for your topics ie your heart is excessively slit then vagal maneuvers can actually make it a bit worse alright so I hope this was useful um I'm really glad to be sharing this with you Julie I hope you're happy with this please feel free to share these videos it means a lot to me if you share them at mine you know it increases the visibility of this channel and it may help other people because I know a lot of you said that you found some of these videos quite helpful I really appreciate that I mean it and I continue to put out some videos for you and in due course if you need to contact me you can do so on my Facebook page my Twitter page or even better on my website your cardiology code UK and and that's about it um thank you so much for listening and I wish you good night you

Channel: York Cardiology

Views: 231,177

Keywords: vagus, palpitations, heart palpitations, gastric, roemheld's, Vagus Nerve (Cranial Nerve), Nerve (Anatomical Structure), skipping, food, reflux, gerd, gord, Heart palpitations anxiety, Heart palpitations after eating, Heart palpitations causes, Heart palpitations symptoms, Heart palpitations treatment, Heart palpitations cure

Id: yvJ7KNIgGQ4

Length: 13min 15sec (795 seconds)

Published: Tue Jul 21 2015

Reddit Comments

[u/BassedCellist]

So interesting about the relationship with eating. I definitely get more palpitations after food, but I always always feel my heart beating uncomfortably fast during and after eating as well, I wonder what the deal is with that.

[u/bright_young_thing]

I do after food too and I eat waaaay smaller meals now which does help.