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What Causes Atrial Fibrillation When Diagnosed With GERD And Sleep Apnea?
Question: I am the guy with Afib, sinus tachycardia. A brief refresh, 2013 had events waking up in morning, AFIB with rapid ventricular response of 174. I was cardioverted. Said I might have sleep apnea and I did. Put on 8 pounds and metotropol 25mgX2. Fast forward a year and during lunch started having bouts of sinus tachycardia which lasted long. Doctor thought it was anxiety and gave me bulspar 7.5mg X2, no effect. It wasn't anxiety and I told doc. I would almost feel like I was dripping adrenaline in my stomach and my heart would take off. Finally went to fire station and heart was 130 after 3 hours so they took me in and slept good with hospital CPAP. Turns out my machine of less than 1 year was not working right and oxygen monitor doctor had me wear was showing 83. Hospital did nuclear test stress and everything was great 67% efraction (reports on my profile)So back to sleep study, up my pressure to 10 and new machine and everything was much better but still felt not 100%. Heart doctor raised metatropol up to 50mgX2 and felt chest pressure and shallow breathing. he felt it was anxiety. I decided to go to the XXXXXXX Clinic since it is a few hours away. I met with the head of EP for cardiology. He listened and said, I bet you have a hiatal hernia and GERD (My sister has this) and this is causing the rhythm disturbances and he put me on Nexium 40mg 1X. He also changed my beta blocker to nadalol 20mgX2. Within 2 days I felt great and my pulse was a bit low at 50 so I called office and the nurse reduced pill at night to half (10mg at night) and the regular 20mg in morning. Doctor stated the half life in the metatropolol was too short and nadalol last all day.
Everything has been great, the cardiologist ordered a 2 week monitor to measure all heart beats which I attached. They said everything looked good and I can exercise. I have lost 20 pounds the last year.
My question is I notice a PVC skipped beat in the morning when I wake up. I also know my afib was when waking up. Should I be concerned?
I notice a sinus arrhythmia also and I am 49 years old so what is this? I do notice every so often my heart rate goes up and down in the same way I breath but not often. Anything to worry about?
The GERD, I was never checked so I scheduled a gastro doctor appointment thinking I should at least get a scope. Although I feel better shouldn't this be validated it is acid reflux? I have no burning nor did I. I did have an occasion where I had a lump in the throat. just recently I worked real late and at at 1030pm and 1 hour later went to sleep(not 3 hours) and I woke up and felt multiple skipped beats then multiple fast (Heart rate turbulence) I believe but it sounds like that is a good thing to have fast beats after a skip.
The report shows sinus bradycardia using at sleep, I realize the pills have slowed but should I be concerned, I see a 38 one time. The XXXXXXX Clinic Dr wants the heart rate 50-70. Whats your opinion?
In closing, I feel I have something wrong with the vagus nerve or something. I think the Nexium is helping and overall I feel good. I did notice in hot XXXXXXX days I get tired more rapidly? I also had a weird thing happen before I had the skipped beats and stomach pain. My right ear was buzzing at a real low frequency on and off. It didn't bother me but it stopped after I slept for 2 days at 9 hours (regular 7) and took a prolosec (my stomach was hurting like it did 20 years ago when I had a few peptic ulcers. Just strange I wasn't feeling right, my ears started ringing and then I was having a few skipped beats. I also was starting to hear my pulse. The last year I haven't heard it. No black stools either. I also take Lisinopril 20mg. My blood pressure has been 105-130/ 60-88. All lab work was very good, nothing outside normal range. No sugar issues(93), Cholesterol (155), tri(218),hdl(32)ratio(4.8) and ldl (79). non hdl chol (ldl+vldl) was 123
Whats your thoughts? I uploaded report cardionet for your review
Everything has been great, the cardiologist ordered a 2 week monitor to measure all heart beats which I attached. They said everything looked good and I can exercise. I have lost 20 pounds the last year.
My question is I notice a PVC skipped beat in the morning when I wake up. I also know my afib was when waking up. Should I be concerned?
I notice a sinus arrhythmia also and I am 49 years old so what is this? I do notice every so often my heart rate goes up and down in the same way I breath but not often. Anything to worry about?
The GERD, I was never checked so I scheduled a gastro doctor appointment thinking I should at least get a scope. Although I feel better shouldn't this be validated it is acid reflux? I have no burning nor did I. I did have an occasion where I had a lump in the throat. just recently I worked real late and at at 1030pm and 1 hour later went to sleep(not 3 hours) and I woke up and felt multiple skipped beats then multiple fast (Heart rate turbulence) I believe but it sounds like that is a good thing to have fast beats after a skip.
The report shows sinus bradycardia using at sleep, I realize the pills have slowed but should I be concerned, I see a 38 one time. The XXXXXXX Clinic Dr wants the heart rate 50-70. Whats your opinion?
In closing, I feel I have something wrong with the vagus nerve or something. I think the Nexium is helping and overall I feel good. I did notice in hot XXXXXXX days I get tired more rapidly? I also had a weird thing happen before I had the skipped beats and stomach pain. My right ear was buzzing at a real low frequency on and off. It didn't bother me but it stopped after I slept for 2 days at 9 hours (regular 7) and took a prolosec (my stomach was hurting like it did 20 years ago when I had a few peptic ulcers. Just strange I wasn't feeling right, my ears started ringing and then I was having a few skipped beats. I also was starting to hear my pulse. The last year I haven't heard it. No black stools either. I also take Lisinopril 20mg. My blood pressure has been 105-130/ 60-88. All lab work was very good, nothing outside normal range. No sugar issues(93), Cholesterol (155), tri(218),hdl(32)ratio(4.8) and ldl (79). non hdl chol (ldl+vldl) was 123
Whats your thoughts? I uploaded report cardionet for your review
Brief Answer:
Do go through the detailed answer. Regards
Detailed Answer:
Hello, I am Dr. Mody and I will be addressing your concern.
I would be precise in my observations so as to clear your doubts and not add to further confusion.
Now a fib is due to a misfire in the electrical circuit of the heart in someone who is prone to it (some genetic predisposition , not all causes known),
So when there is a precipitating cause (in you sleep apnea, hypertension, obesity and Gerd - all had a role)
So how is it important to us, because if we treat the precipitating cause optimally, the afib may be treated my itself or at least the medication dose needed will be minimum.
Hence the care you should take.
1) cpap should be taken such that at times you oxygen saturation is maintained above 90% atleast, more it is better
2) treatment of hypertension - lisinopril is a good drug and you should continue as the pressure reading mentioned by you are good
3) Gerd, surely there seems to be a component of reflux and with history of peptic ulcer, take neksium for atleast 6-8 week s for complete resolution. Also important to note here is using cpap can itself increase the reflux.
4) lose weight to reach Bmi of 25, this will align the stomach more with food pipe decreasing reflux. Also it will help in your sleep apnea, hypertension and indirectly in afib
Things you should not be worried.
1) premature beats, it is present even in normal individual and just because a holter was done you could notice it, but also it's because if hypertension, sleep apnea combined, but trust me it's of no clinical significance.
3) lipid are grossly normal, and no medication needed for same, however try bringing HdL more than 50
Lastly, anxiety will push more adrenaline in the circulation worsening a fib, so try staying calm even when you feel the heart racing, because many a times it might be subjective.
The sinus tachycardia episode mostly are due to Gerd with reflux.
38 is a bit low, resting heart rate between 50-60 is preferred, so a dose modification of nodalol as needed may be discussed with your cardiologist.
Thyroid level should be checked once as they may cause a fib.
Sinus arrhythmia are normal phenomenon which happens with respiration, it is present in me as well as ppl around you. It's just clinically silent and so we don't notice it.
If I have missed upon anything, let me know also I will be happy to further clarify.
Hoping I could help.
Regards Dr Priyank Mody, Cardiologist, XXXXXXX
Do go through the detailed answer. Regards
Detailed Answer:
Hello, I am Dr. Mody and I will be addressing your concern.
I would be precise in my observations so as to clear your doubts and not add to further confusion.
Now a fib is due to a misfire in the electrical circuit of the heart in someone who is prone to it (some genetic predisposition , not all causes known),
So when there is a precipitating cause (in you sleep apnea, hypertension, obesity and Gerd - all had a role)
So how is it important to us, because if we treat the precipitating cause optimally, the afib may be treated my itself or at least the medication dose needed will be minimum.
Hence the care you should take.
1) cpap should be taken such that at times you oxygen saturation is maintained above 90% atleast, more it is better
2) treatment of hypertension - lisinopril is a good drug and you should continue as the pressure reading mentioned by you are good
3) Gerd, surely there seems to be a component of reflux and with history of peptic ulcer, take neksium for atleast 6-8 week s for complete resolution. Also important to note here is using cpap can itself increase the reflux.
4) lose weight to reach Bmi of 25, this will align the stomach more with food pipe decreasing reflux. Also it will help in your sleep apnea, hypertension and indirectly in afib
Things you should not be worried.
1) premature beats, it is present even in normal individual and just because a holter was done you could notice it, but also it's because if hypertension, sleep apnea combined, but trust me it's of no clinical significance.
3) lipid are grossly normal, and no medication needed for same, however try bringing HdL more than 50
Lastly, anxiety will push more adrenaline in the circulation worsening a fib, so try staying calm even when you feel the heart racing, because many a times it might be subjective.
The sinus tachycardia episode mostly are due to Gerd with reflux.
38 is a bit low, resting heart rate between 50-60 is preferred, so a dose modification of nodalol as needed may be discussed with your cardiologist.
Thyroid level should be checked once as they may cause a fib.
Sinus arrhythmia are normal phenomenon which happens with respiration, it is present in me as well as ppl around you. It's just clinically silent and so we don't notice it.
If I have missed upon anything, let me know also I will be happy to further clarify.
Hoping I could help.
Regards Dr Priyank Mody, Cardiologist, XXXXXXX
Above answer was peer-reviewed by :
Dr. Sonia Raina
Doctor,
Thank you for the responses. I just have a few follow ups and I will close it out.
1) My mother died at 55 with Arrhythmia issues, I know she had a pacemaker/Defib so I agree with the predisposition so I will need to play close attention. I have to recognize I have a most likely genetic issues acerbating the Electrical system. With that said under medication do you feel this will be a solution or does this present further issues with age meaning will I potentially get worse, right now I feel very good.
2) The pulse rate at night seems low as we discussed but reality is the pulse seems to be right on target based on the 2 week heart monitor. My Doctor didn't seemed concerned so since I do monitor daily, if I get a low pulse readings when should I be concerned to call him? I don't want my heart just to stop beating. I check randomly daily and its around 57-65.
3) Do you feel its safe to execise and how long, don't want to stress my heart. Strange now that my pulse is 50-70 I get nervous when its 90. I actually probably need to change that mind set and actually get it going that high. I'm sure its not good for it to be 50-70 all the time.
4) I know you strictly look at facts. Is there anything around the vagus tone that may be the issue. Just seems that the Vagus nerve plays an active role and didn't know if there is a way to test that to insure I don't have sick sinus syndrome. I don't think so and probably are reading too many articles. I know it sounds like I have anxiety, there may be some but I want solutions and I don't want to die. Just want to turn every rock and get the right regiment to be healthy. Overall I feel very good.
That's it, thank you and I will close out. No more questions
3)
Thank you for the responses. I just have a few follow ups and I will close it out.
1) My mother died at 55 with Arrhythmia issues, I know she had a pacemaker/Defib so I agree with the predisposition so I will need to play close attention. I have to recognize I have a most likely genetic issues acerbating the Electrical system. With that said under medication do you feel this will be a solution or does this present further issues with age meaning will I potentially get worse, right now I feel very good.
2) The pulse rate at night seems low as we discussed but reality is the pulse seems to be right on target based on the 2 week heart monitor. My Doctor didn't seemed concerned so since I do monitor daily, if I get a low pulse readings when should I be concerned to call him? I don't want my heart just to stop beating. I check randomly daily and its around 57-65.
3) Do you feel its safe to execise and how long, don't want to stress my heart. Strange now that my pulse is 50-70 I get nervous when its 90. I actually probably need to change that mind set and actually get it going that high. I'm sure its not good for it to be 50-70 all the time.
4) I know you strictly look at facts. Is there anything around the vagus tone that may be the issue. Just seems that the Vagus nerve plays an active role and didn't know if there is a way to test that to insure I don't have sick sinus syndrome. I don't think so and probably are reading too many articles. I know it sounds like I have anxiety, there may be some but I want solutions and I don't want to die. Just want to turn every rock and get the right regiment to be healthy. Overall I feel very good.
That's it, thank you and I will close out. No more questions
3)
Brief Answer:
Do go through the detailed reply. Regards
Detailed Answer:
Hello,
1) in most probability your mother had sick sinus syndrome, or some conduction abnormality, so she was put on defibrillator /pacemaker. So in a way her heart electrical system was not working upto the mark to form and conduct an electrical impulse. So she was at a risk of sudden cardiac death. While in you it's the extra circuits which are hyperactive, so in no probability is your heart going to stop. Just don't worry about the same.
Also in present , pacemaker is third line treatment for a fib and medication is the best treatment.
2) heart rate monitor is more precise way of monitoring pulse, so if that working withen normal range, just font worry
3) as I said in your mother the vagal tone may be higher so there was sick sinus, in you vagal tone has minimum clinical implication as far a atrial fibrillation is concerned.
If you had sick sinus syndrome we would have got it on ekg / holter. So don't worry about the same too.
4) beta blocker are the best drugs for atrial fibrillation, it's just dose titration which is important, and XXXXXXX is one of the best centers in the world foe ep
Now two important aspects.
1) you should take anti coagulation for a fib to prevent the risk of stroke, as you haven't mentioned anything about the same, i thought I should point out
2) your atrial fibrillation has been controlled food by medication, the second line is epic study and ablation, however it's Inferior to good medication treatment because of recurrence.
I do understand the trauma of untimely demise of your mother. However a fib is not that severe a condition and sudden stopping of heart is very very very rare of certain other Co existing condition is present and not .
Regards Dr Priyank Mody
Do go through the detailed reply. Regards
Detailed Answer:
Hello,
1) in most probability your mother had sick sinus syndrome, or some conduction abnormality, so she was put on defibrillator /pacemaker. So in a way her heart electrical system was not working upto the mark to form and conduct an electrical impulse. So she was at a risk of sudden cardiac death. While in you it's the extra circuits which are hyperactive, so in no probability is your heart going to stop. Just don't worry about the same.
Also in present , pacemaker is third line treatment for a fib and medication is the best treatment.
2) heart rate monitor is more precise way of monitoring pulse, so if that working withen normal range, just font worry
3) as I said in your mother the vagal tone may be higher so there was sick sinus, in you vagal tone has minimum clinical implication as far a atrial fibrillation is concerned.
If you had sick sinus syndrome we would have got it on ekg / holter. So don't worry about the same too.
4) beta blocker are the best drugs for atrial fibrillation, it's just dose titration which is important, and XXXXXXX is one of the best centers in the world foe ep
Now two important aspects.
1) you should take anti coagulation for a fib to prevent the risk of stroke, as you haven't mentioned anything about the same, i thought I should point out
2) your atrial fibrillation has been controlled food by medication, the second line is epic study and ablation, however it's Inferior to good medication treatment because of recurrence.
I do understand the trauma of untimely demise of your mother. However a fib is not that severe a condition and sudden stopping of heart is very very very rare of certain other Co existing condition is present and not .
Regards Dr Priyank Mody
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Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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