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Experiencing loud heartbeat and breathing difficulty. Taking omeprosol for acid reflux. What to do?

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Hi, I was wondering if you could help? I keep experiencing an intermittent loud heartbeat every so often. I was out with friends on Friday night and had only one drink before this happened. Happened again a few times throughout the evening. Happened again the following night. Heart rate does'nt appear to speed up mostly but has a on a few occasions it has done. Bit scary when it happens as it seems to take my breath away a bit. I am on Omeprosol tablets for acid reflux and they have helped but still get the loud heartbeat and chest pains every so often. I have had a number of ecg's over the past 12 months due to chuting/tightness pains in my chest and breathlessness and have been told everything is great. Cholesterol overall at 5.8 so a bit high and on a diet. I do try to exercise regularly and don't have chest pain when exercising. Hope you can help?
Posted Thu, 14 Feb 2013 in Hypertension and Heart Disease
Answered by Dr. Anantharamakrishnan 1 hour later
Hi friend,
Welcome to Health Care Magic
This feeling of ‘dropping / skipping / missed’ / fast / irregular beating is termed ECTOPIC beats (ARRHYTHMIA).
A beat comes earlier than normal – this itself is not usually felt. The next beat is a bit delayed - longer time to recover form early extra beat – so heart fills more and the beat appears forcible thud / lubb - - dubb - - lubb - - dubb - lubb - - - DUBB /

Ectopic beats can arise from ventricle (lower chamber of the heart - Ventricular Ectopic; VPC) or Atrium (upper chamber - Atrial Ectopic; APC).
APCs are generally harmless. Even VPCs are often harmless – ‘benign’.
Anxiety / Alcohol / Tobacco (smoking) / Caffeine (too much coffee, cola) are common causes.
Medicines may be responsible – like Phenylephrine used for ‘cold’ / Salbutamol used for asthma and so on.
At times, abnormal nerve paths in the heart (bypass tracts) are responsible!

These beats are common and often may be normal. It is advisable to have it investigated.

A thorough history and physical examination is the first step -
ECG (Electrocardiogram / EKG) – Routine 12-lead – is part of clinical examination.
HOLTER is done to analyse and plan for further management, if a routine ECG does not show, 24 to 48 hour ambulatory monitoring
TMT (Treadmill exercise ECG) is done to exclude Ischemia (reduced blood flow).

ECHOcardiogram is necessary to see the heart valves (Mitral Valve Prolapse) / heart muscle (Cardiomyopathy) and heart function (Ejection fraction, wall motion abnormality).

LABORATORY work-up is routine - like blood counts, sugar, urea, electrolytes (potassium in particular), thyroid (over-active) and so on. Your Internist shall suggest based on the situation.
If there are no clues and if the problem is still bothering to the extent of interfering with life style, there are advanced techniques – Electro Physiological Stdies (EPS) > it resembles angio – a catheter is put inside the heart / electrical activity recorded / stimulation and suppression tests are carried out / suitable medicine tested and so on. Though the test is the gold standard, it is INVASIVE and has a risk (though minimal) and is not generally done unless there are compelling indications. This super-speciality expert is called ELECTRO-PHYSIOLOGIST. The treating doctor may suggest them depending on need, based on his assessment of the situation.
Specific treatment may not always be necessary.
The first line medicine is generally beta blockers, like Metoprolol – slow release and small dose. It will benefit both anxiety and missed beats. Your doctor will give proper prescription and follow up

If they are not effective and if the problem is severe, several other classes of drugs are available – acting by different mechanisms - the specialist will decide tailored to your needs / they may have side effects and need follow up.

There are other advanced treatment modalities - like RF ablation, which could be done during EPS.

Stop alcohol.
See Heart specialist.
It is easily treatable.

Take care
Wishing speedy recovery
God bless
Good luck
Above answer was peer-reviewed by
Follow-up: Experiencing loud heartbeat and breathing difficulty. Taking omeprosol for acid reflux. What to do? 17 minutes later
Hi, Thanks for the answer.

I have had a ECG and was given the all clear. Had full goup of blood tests last march after complaining about this issue. Regularly us x-trainer and treadmill with no ill effects.

Thought this issue was linked to alcohol so stayed off the alcohol for a while, then drank again with no issue for a while. Might be alcohol linked again but not sure. How does alcohol or anxiety effect heart rythum?

Could this also be linked to acid reflux? I am taking omeprozole after complaining about chest pain and being diagnosed potentially with gords. Seems to have reduced the effects I was suffering from. I did alo suffer with Panic Attacks/Anxiety for long periods last year. Start new job next week that has been playing on my mind also.

Do you think this might be anxiety linked. I also use a salbutanol inhaler regularly for my asthma
Answered by Dr. Anantharamakrishnan 40 minutes later
Hi ,

A routine ECG may not show
An event monitor for 24 to 48 hours can help.

Good exercise capacity and normal treadmill test exclude ischemia (Coronary Artery Disease) as the cause. Blood tests exclude thyroid and electrolyte as causes.
There could be other causes! - requiring other tests!

Acid reflux has no direct relation to the missed beats.
Anxiety stimulates the Sympathetic nervous system and causes this.
Anxiety leads to arrhythmia > arrhythmia leads to anxiety > a vicious cycle.
Salbutamol is a beta-agonist and stimulates the Sympathetic nervous system.
Alcohol directly affects the nerves of the heart and causes this (Holiday Heart Syndrome!) / In long term, it can also damage the muscle (Alcoholic Cardiac Myopathy)

More than one factor could be contributing - here is alcohol, anxiety and Salbutamol. Avoid alcohol / Reduce Salbutamol / Treat the anxiety - positive attitude, relaxation techniques and/or drugs.
Most probably, you will settle down after the new job?!

Above answer was peer-reviewed by
Follow-up: Experiencing loud heartbeat and breathing difficulty. Taking omeprosol for acid reflux. What to do? 7 hours later
Thanks Doctor

This is probably the most insightful answer i've ever had about this issue so many thanks.

I had heard of holiday heart before, but did'nt realise that alcohol had such a direct effect. I am married with children now so don't drink much at all these days, but used to frequently drink when younger without a problem. Could this be due to drinking too much in the past and this catching up with me? Also had a good few drinks over the xmas period without any problem whatsoever, so thought i had got passed all this. Will stay off the alcohol from now on.

My main worry is that I suppose this effects normal heart rythm and i know with so many high profile cases recently, especially with Fabrice Mouamba (english footballer who suffered cardiac arrest in the middle of a game last year), that when the heart develops a diffferent rythm it can lead to fatality. Is this possible with Ectopic beats or can they not cause a fatal heart rythm?

Can certain foods contibute to Ectopic Beats?

I also use a preventer inhaler for my ansthma, to reduce the need for salbutamol. Does this contain anything that could trigger the ectopic beats? It is a Beclometasone Dipropionate (Clenile Modulite).

I also take Garlic Tablets and Cod Liver Oil tables daily in order to ensure healthy heart and eat plenty of oily fish such as mackerel.

As I said in the first email, my overall cholesterol level was 5.8 (should be 5 or less) and I'm trying to lose weight to get it down. Could high cholesterol also contribute to the ectopic beats?

Are there any foods etc I could eat to reduce their effects?

Best Regards

Answered by Dr. Anantharamakrishnan 2 hours later

It is a great and welcome decision to stop alcohol.
You have the motivation.
That is the first and most important step.
Keep it up.
You will succeed.
Take your spouse into confidence. Avoid friends and situations that tempt. Find out social support groups in your locality – Alcoholics Anonymous (AA)

The immediate effects of alcohol wear of over a few hours.
The liver has limited capacity to handle – it can not ‘catch up’. The insult to liver typically takes days; sometimes irreversible.

Ectopic beats are generally not catastrophic – the problem ones usually are ventricular tachycardia or flutter that ends in ventricular fibrillation. Muamba survived, Morosini died. The reason is more likely to be an underlying undiagnosed heart muscle disease (Cardiomyopathy), probably inherited and/or unusual nerve paths or valve or vessel defects. It is very rare indeed... Regular exercise helps, not harms. Don’t worry. Get investigated and be assured...

Food usually does not contribute. They are broken down in the gut, handled by the liver and so on.

Preventive medicines for asthma – Beclomethasone / Cromoglicate / Montelukast and so on – do not cause arrhythmia.

High cholesterol thickens the arteries. It does not cause ectopic beats.
The first and most important step is Life style changes – Diet and exercise.
It has to be life-long for a long life. So see a specialist in the field.
A dietician will be of great help. You may need a few sessions mastering the nuances – weight reduction and low cholesterol diet. A drug like statin may be needed. Start a supervised exercise program and with time, you can be on your own.

Good luck
God bless you
Above answer was peer-reviewed by
Follow-up: Experiencing loud heartbeat and breathing difficulty. Taking omeprosol for acid reflux. What to do? 1 hour later

Do you think the heart sensations could be 'un-heart related. Reason I ask is having complained to my doctor previously, I was told that some of the sypmtoms I was having mimicked severe indegestion.

When I get the loud heartbeat sensation, I have checked my pulse and it does'nt appear to have either sped up or missed as beat each time it happens. I do get a faster pulse on some occurences.

Your opinion is valued
Answered by Dr. Anantharamakrishnan 13 hours later
Awareness of heart beats I called palpitation.
It may be the rate (fast or slow) / rhythm (regular or irregular) or the force (weak or strong).
You are mostly referring to the force - this is often from a thin chest or anxiety. Also, when the rate is slow or after an early ectopic beat, there is more time to fill and more volume pumped in a beat (stroke volume) - one may become aware.

Again hiatus hernia and stomach pushing up diaphragm can draw attention.

Heart symptoms can mimic digestive symptoms - for example, a heart attack involving the inferior wall may present as stomach pain and vomiting.
The other way also is true - stomach symptoms may mimic hear symptoms. Spasm of food pipe (oesophagus), hiatus hernia and reflux cause chest symptoms.
But a good history itself very often resolves - digestive symptoms are related to food; heart symptoms are related to effort. Examination will give more information.
Investigations will confirm - an endoscopy, for example, can rule ot reflux and hiatus hernia. Occasionally both may be present! - one does not exclude the other. Relevant tests rule in or rule out.


Above answer was peer-reviewed by
Follow-up: Experiencing loud heartbeat and breathing difficulty. Taking omeprosol for acid reflux. What to do? 7 hours later
Thanks Again

How does Oesophagus spasm work and why? I have heard this referred to as Cardiac spasm as its made up of cardiac tissue and reflux can effect this.

Can heat make heart rate increase. Sometimes use teh sauna at the gym and can feel heart rate increase sometimes. Is this due to the body trying to cool itself?

Also, hit the gym last night. x-trainer, rowing machine and weights with no ill effect?
Answered by Dr. Anantharamakrishnan 2 hours later

Cardiac sphincter and spasm are misnomers – WRONG NAMES. Generally, the oesophagus works like a wave – from above down, pushing the food. At times, areas of focal contraction occur – spasm.
It is NOT made of cardiac tissue. It is like any other 'smooth muscle' of intestine.
If the lower oesophageal sphincter is weak, reflux occurs. Failure to relax is a feature of Achalasia Cardia (cardiac spam) – old name, given by mistake. It has nothing to with heart.

Yes, heat can increase the heart rate. Blood vessels are dilated by heat. So, the heart has to pump faster to keep the blood supply. Fever isa typical example.

Isometric exercise is the bad one. Isotonic is a part of heart training!

Above answer was peer-reviewed by
Follow-up: Experiencing loud heartbeat and breathing difficulty. Taking omeprosol for acid reflux. What to do? 19 minutes later
What is Isometric Training and what is Isotonic Training?
Answered by Dr. Anantharamakrishnan 1 hour later

If the muscle length is same / only the tension increases / it is isometric exercise.
'Bull worker' is a typical example / Valsalva manoeuvre...
It increases the pressure inside chest and is not good for heart.

In Isotonic, the tension does not change. the length of muscle changes - walking, jogging, cycling and so on.

Training - gradually stepping up, under expert guidance.

Above answer was peer-reviewed by
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