The gastrocardiac syndrome - heart palpitations caused by the stomach

a consultant cardiologist in York Hospital in the UK and um today I wanted to talk to you about the gastrocardiac syndrome okay the gastrocardiac syndrome now a lot of people I've spoken to have asked me um are could my palpitations be related to my stomach because a lot of people have found that when their stomach is full or when they're getting indigestion uh that that seems to um that seems to uh trigger off their palpitations and make their palpitations much worse and many people have said look you know what is the relationship there okay and um therefore I did some research and I thought I'd discuss this syndrome called the gastrocardiac syndrome which really is a term which links both the stomach and the Heart together and explains why some stomach symptoms can make heart symptoms worse okay so how these both the stomach and the heart are intertwined um the first thing to say is that um often how do you think why why should you think you have the gastrocardiac syndrome because you may have symptoms which uh consist of both so belching nausea heartburn erasing heartbeat irregular heartbeats changes in blood pressure um and so you're getting symptom both from the stomach and when you get those symptoms you get symptoms from the heart and that's when you should think about the gastrocardiac syndrome not many people think about this um not even many doctors think about this but um it does exist okay now there are a few things to try and uh talk to you first about linking these two systems together the first thing to say is that the stomach and the heart are in closed proximity anatomically they're very close to each other okay and remember the stomach doesn't just consist of the stomach you have the esophagus as well so although the stomach is below the diaphragm the esophagus is actually you know your food pipe goes right from there through your diaphragm and links into the stomach so this part of the food pipe the food pipe is above the diaphragm so to speak and um so the heart on the other hand is just located um here okay on the left side above the diaphragm and the food pipe goes down here sorry I can't show this the food pipe goes down here and the stomach is here so they're very closely related and in fact when I sometimes have to look at the heart in a bit more detail I often put a probe down into the food pipe and look at the heart that way because they're so close to each other so there is this anatomical proximity um the second thing to say is that um The Innovation of the stomach and the heart is um supplied by the same nerve which is the vagus nerve okay so the nervous system is the same um and that is another reason why the heart something that happens to the stomach can cause something in the heart and uh vice versa because the Innovation is the same the third thing to say is that the medications that people take for the heart can affect the stomach and medications that people take for the stomach can affect the heart and I'll go into these in more detail and finally there are certain things that can go on in the body which can affect both so let's talk about the anatomical relationship first and how the anatomical relationship can cause heart rhythm abnormalities um the first thing to say is that if for a lot of people these days um reflux is incredibly common okay and that is undoubtedly due to diet and weight gain Etc but very many people now uh have reflux disease and very many people take proton bump Inhibitors uh for their reflux disease reflux disease when I was a young boy used to be a disease of fat people but now we see reflux in very young in very thin people uh and um this really reflects a bad lifestyle which we're all forced to live these days because of processing and supermarkets etc etc so now what can happen is if you have a very full stomach okay now you can't see this if you have a very full stomach what can happen is that the stomach can push against a diaphragm okay if you are very bloated if you have very full stomach the stomach can push against the diaphragm and when it does so it can change it can compress it can impinge on the heart because the DI fragm moves upwards and that can change the position of the heart and any change in position of the heart can trigger off palpitations the second thing to say is more often what can happen is a bit of stomach can actually come through the diaphragm and get pulled up so what happens is your food pipe which is meant to go all the way down and then open into the open into the stomach which is below the diaphragm what can actually happen is a bit of stomach can actually come through the diaphragm and be above the diaphragm okay so what what essentially happens is that you have a little bit of stomach above the above the diaphragm and that's called a hiatus hernia now what can happen there is that you can that can really press on the heart okay because you've got it right next to the heart and so if you have a high Heria that can do more um that can press on the heart heart even more um and and therefore people with Hiatus heras often get heart palpitations and they can also get chest pains which are indistinguishable from heart pains um because of the Hiatus henia uh so that is the anatomical relationship so when people talk about well I get my palpitations on a false on a very when I'm feeling very bloated or I've got a lot of gas that's what's happening it's pushing against the heart changing its position and therefore triggering off the palpitation the second thing uh to talk about is the vagus nerve now the vagus nerve is a nerve which innovates a large part of the body but in particularly the heart and um and the stomach now what this the the the the role of the vagus nerve is to slow the heart down okay now what happens is we um have a pacemaker we're all born with a pacemaker that God gives us okay and that uh dictates how what our heart rate is going to be so um your pacemaker sits there and it fires at a certain rate all right now if you slow the Heart below that certain rate then you can allow other parts of the heart to generate impulses because the pacemaker has this controlling function it's an orchestrator so it stops everything else from firing because it's got this certain rate at which it will fire you should watch my video on the vegus nerve and that'll explain it a bit better but if you suppress the heart rate below the inherent rate of the pacemaker you can trigger off palpitations now that is what was called the romeal syndrome where a bloated stomach can compress on the vagus nerve and activate the vagus nerve and the vagus nerves pushes the heart rate down and that allows other areas of the heart to trigger and that's why people complain of ectopic beats and palpitations often people say to me well you know why does it happen in relation to certain postures I changes in posture so if I'm lying on my right hand side I notice more or if I'm lying on my left hand side I notice it more and so I did some research and I found an interesting uh paper where now let me see if I can find this paper for you um here here it is I think yeah uh there was a paper by Chen c h n and KU kuo okay in anastesia in 1997 uh Edition 52 Pages 653 to 657 if you if you want it just send me a message and I'll send you the paper um but in that what they did was they looked at different positions line positions on the veicle tone all right and they found that out of the three out of three positions I.E if you lie in your on your right side uh compared to your lying on your left side compared to lying flat on your back lying on your right side has the largest effect on the vegus Nev it stimulates the Vegas n by more than the other positions the left does it slightly less and the least is done by the least veal activation occurs when you're lying flat on your back so that is why some people find that when they're lying on their right hand side they get more palpitations because the vagus nerve is activated more when you R lie on your right hand side okay and that's um that's um another reason why posture changes sure it can also happen on the left hand side but apparently I mean and you know know some people get it more on the left hand side um and I'm not and I'm sure that that's also because you get more vagal nerve activation but if it was a choice of three positions you're best off lying on flat on your back rather than lying on your right hand side uh so if any of you're lying there and you're getting palpitations and you want to work out whether it's because of vagal nerve um stimulation try and change position and see what effect this has okay then there is a third uh link between the stomach and the heart and that is the influence of medications okay so we know that things for the things for the heart like things like aspirin uh will cause stomach irritation however we also know that medications for the stomach particularly proton pump inhibitors Okay so lansoprazol omeprazol esomeprazol these drugs what they do is they inhibit the production of acid in the in the in the stomach now the problem is that by doing so what they can do is they can reduce the absorption of some vital nutrients that need to be absorbed so they can inhibit the absorption of iron they can inhibit the absorption of vitamin B12 and they can certainly inhibit the absorption of magnesium all right and there therefore we know that people who are on proton pump inhibitors can become hypomagnesemic and we also know that a relative hypomagnesemia can cause ectopic beats and that's why we find that a lot of people who take magnesium have a reduction in their ectopic beats the problem is that if you're on a proton pump inhibitor you're not absorbing your magnesium so taking in all magnesium is not going to make that much of a difference because the Magnesium simply won't get absorbed for this what you have have to do is you have to come off the proton pump inhibitor for a few days and then after about three days of stopping the proton pump inhibitor go on the Magnesium replenish your stores and then see what happens finally there is the issue of inflammation now if you have inflammation in your stomach chronic inflammation then that inflammation is a huge stress s to the body okay so if you have reflux the the inflammation that goes on that in itself can trigger off palpitations because any form of inflammation within the body can trigger of palpitations as well so those are the four ways in which the stomach and the heart are linked um and really to my mind the things I would recommend out of this video are one try and avoid having a bloated stomach two try and eat those foods which are good to try and avoid stomach problems three if if you're on a proton pump inhibitor just be aware of this possibility that you may be short of some vital nutrients like iron and magnesium and it may be worth coming off the proton inhibitor for a few days replenishing yourself with magnesium to see what happens and finally if you're in the middle finally if in the middle of the night you start getting these palpitations try and change position I lie on your back or lie on the left lateral position if you're noticing them more on the right lateral position and that may help your symptoms so I hope this was useful um my um name as I say is San Gupta um I work in New York Hospital I have a website which is www.you cardiology.com website because I'm more likely to answer it because it comes straight to my phone if you need to speak to me or if you need to contact me you can do so on um 01 19472 5811 where you will be um uh greeted by my secretary Janette uh you can also contact me on Facebook if you like here you go and Twitter so I hope this was useful uh and um I wish you all the best thank you for listening

Channel: York Cardiology

Views: 1,645,983

Keywords: Stomach (Anatomical Structure), Palpitation (Symptom), Syndrome, heart palpitations, ectopics, GERD, pvcs, pacs, ectopic heart beats, reflux, ppis, Heart palpitations anxiety, Heart palpitations after eating, Heart palpitations causes, Heart palpitations symptoms, Heart palpitations treatment, Heart palpitations cure, Ventricular ectopics, Heart disease symptoms, Heart racing, Heart flutter causes, Heart palpitations at night

Id: zt4Cw-VKIlY

Length: 14min 36sec (876 seconds)

Published: Sun Oct 25 2015