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What causes arrhythmia after swallowing food?

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Posted on Sat, 17 May 2014
Question: Heart related, PVCs since I was 15, now a 56 year old male. Benign arrhythmia comes and goes over the years. As I get older, it seems more frequent. Dec 2013, had Stress/Echo, passed. Was generating PVCs before and after treadmill, none during. Though I avoid caffeine, I had given up Chocolate for Lent 2014. Easter resumed eating chocolate, quite a few pieces over the day. Monday following Easter, woke with persistent arrhythmia. The frequency concerned me, so by 1:00 P.M. Monday went to E.R., had Frequent PVCs and PACs, 3 to 1 respectively (approximately). Discharged from E.R., and I contacted my Cardiologist who viewed the E.R. EKG, blood tests, and observations. My Cardiologist feels that there is no reason for concern. Though I mentioned it to him, with him still unconcerned, I get into bigeminy and quadrigeminy. I have no pain, no shortness of breath, no dizziness, and if I couldn't feel them I'd have no diminution of activities. But they are driving me nuts. I'm in bigeminy for episodes throughout the day, and when I lay down at night, it's constant quadrigeminy. In addition to this, my stomach roils, you can hear it across the room. Last year, I developed a situation that persisted for a few weeks where if I swallowed food, my heart would experience an isolated ectopic with each swallow. I'm at wits end, it's hard to believe that this many is of no medical significance, but without knowing others going through the same thing, just reading the plights of others doesn't seem to help. I take Atenolol, Klonopin, Hyzaar/HCTZ, Levothroxine, Phenytoin, ASA. My anxiety level is through the roof. Traditionally, I'd get many PVCs when tense, such as work meetings. Though I've had limited bigeminy before, these episodes are protracted, but it does eventually resolve for short to moderate times. The quadrigeminy is new. I've been told by a neurologist to consult an Autonomic Nervous System specialist for other reasons. And I've convinced the cardiologist to do a Holter on Monday. How can I mentally survive this, the doctors are unconcerned, my brain unconvinced, and, where can I guide my doctors, test wise or medication wise.
doctor
Answered by Dr. Veera Raghava Rao Buddha. (12 hours later)
Brief Answer:
It may be the gastro enterology problem.

Detailed Answer:
Hi, Welcome to Health care magic forum.
You are having the problem, from the age of 15 and now 56 years.It is not diagnosed, and you are safe.
You have no pain, shortness of breath, and the tests stress and echo tests not suggestive of absence any cardiac problem.
Your stomach roils and it is audible through out the room, with each swallow of food, you feel the heart is feeling ectopic episodes.
It most probably suggests that there is some thing related to the stomach and there might be some narrowing of the esophagus.
Your neurologist didn't find any reason for this.
You are using the atenolol, clonopin, hyzar, hydrochlorthiazide,levo thyroxine, phenotoin, and A.S.A.
If you are using all these medicines, by prescription, do you have hypertension, hypothyroid, epilepsy, etc. All these drugs can cause the gastric irritation.
levothyroxine can cause palpitations,if taken in over dose, or with out prescription.
I advise you to consult a gastroenterologist , and psychologist for diagnosis and treatment.
As you have I.B.S, epilepsy, I.B.S can directly cause hyper motility of the stomach.
If the dose of the phenetoin is sub clinical you can have internal reaction like this. Your neurologist can find if dose is correct or not.
I usually prescribe to my patient with such symptoms ranitidine, domperidone, and antacid gel, and alprazolam at night.
Anemia can cause such feeling, so i advise you to verify, and use protein supplements, if iron don't use oral form, take the injections with your doctors advise if there is anemia.
Take more of green leafy vegetables, pulses, sprouts, and protein rich foods to improve general health, resistance, and blood picture.
Wishing for a quick and complete recovery.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Veera Raghava Rao Buddha. (3 hours later)
Hi Doctor, thank you for your thoughts.

New Information: I failed to mention that I have MVP, or so half the Cardiologists I've seen over the years claim. It's believed to be intermittent. Several years ago, I experienced an ectopic beat, fell into a brief rapid breathing episode that was terminated by the occurrence of another ectopic beat in much less than a minute. My cardiologist thought it related to the MVP, I've had 2 or 3 stress echo tests since that time.

Elaboration of existing information: To clarify, I've been getting PVCs since I was 15, probably at the level of dozens to hundreds per day. Since then, at times in the intervening years, often in several bouts a year, I get periods of weeks to months where I have hundreds to thousands of PVCs/day, as documented by Holter Monitoring and documented on EKGs associated with Echo Stress Tests (before and after coming off the treadmill), but no PVCs occurring, or occurring in low numbers, during the stress test itself.

I had, at one time, an elusive fast pattern that I had to wear an Event Monitor for 10 days to catch, turned out to be Non-Re-Entrant PSVT. This is not a factor now.

Last Monday I awoke with a very persistent arrhythmia, not unlike what I usually feel, just in patterns, most of the ectopics I usually feel are isolated. Bigeminy being one pattern, alternating ectopic and normal beats. They come in episodes of 4 to 10 such repeated patterns, I'm a little tired during this pattern, and back to normal rate briefly, then repeats. It's not absolute, but at times I'm hard pressed to take my pulse over 15 seconds without intervening ectopics or falling into bigeminy. This caused me to go to the Emergency Room as described in my original question and to follow-up, by phone, for his interpretation of the E.R. test results.

Monday, Tuesday, and Wednesday, I was in quadrigeminy while trying to fall asleep, Thursday and Friday, seemingly normal rhythms once my heart settled after laying down, and Saturday I was in bigeminy.

I had a Total Thyroidectomy due to cancer that was discovered while a CT Imaging study was being done to assure no pathology of the Vagus Nerve, since, at that time, in the evening, everytime I swallowed food (but not liquids) I would experience a single ectopic beat with each swallow. My Cardiologist assured me it was a Vagal response, but I visited my Neurologist as well, and he ordered the CT. No pathology was noted concerning the Vagus Nerve, but thyroid nodules were noted.

Post Thyroidectomy, I take 300 mcg Levothyroxine qd. Though my family physician said that my TSH was on the low side, the ENT Surgeon that removed my thyroid and maintains my Levothyroxine prescription says it's fine, but I suspect he's trying to keep the thyroid levels to the high side to prevent recurrence of the cancer.

I have Temporal Lobe Epilepsy and take 300 mg Phenytek (Phenytoin) bid, and have blood levels of 19 mcg/ml.

I awoke this morning, still with the episodes of bigeminy and quadrigeminy. Walking stairs with few to no ectopics (except for my first journey up the stairs which maintained the ectopics I was having when I awoke) but all together they quieted while writing this response, that is until I had breakfast, whereupon they have returned in abundance.

IBS was an old, not current diagnosis. But it was/is part of my history.

As I said, I am experiencing no functional loss, no pain, no shortness of breath. My biggest issues are the fear of the arrhythmia, fear of falling asleep because of it, and loss of enjoyment of eating. I'm not seeking your assistance as a primary care source, still following up with my Family Physician and Cardiologist, and if I couldn't feel it would have little awareness otherwise of it's occurrence.

How frequent are these types of rhythms, bigeminy, quadrigeminy, frequent PVCs and PACs, and why are doctors so confident that, after examining test results, that despite the frequency of them and patterns, that they are of no concern (if determined to be benign). They are maddening to me.

By the way, I'm 6'2" and weigh 295 lbs and Caucasian.
doctor
Answered by Dr. Veera Raghava Rao Buddha. (15 hours later)
Brief Answer:
prolapse mitral valve,dose of levo thyroxine.

Detailed Answer:
Hi,
You are primarily diagnosed as the case of mitral valve prolapse, which can cause any arrhythmia. It is not excluded so it may be the cause, it can cause weakness occasionally. But as there is no decompensation, it need not be considered to be worried.

P.V.C, premature ventricular contractions are been confirmed, but as they are not hazardous - considered benign.

P.S.V.T, paroxysmal supra ventricular tachycardia, usually associated with palpitation, chest pressure, and light headedness, they are not the issues, and it is no more an issue.

Total thyroidectomy is done and there are still nodules, they can send secondaries, to vagus down in position.

Thyroxine is in high dose,and that is considered to be necessary.

After breakfast you was getting, it may be more aggressive, may have to be accommodated.

I.B.S. is not an issue but it could be chronic and benign.

You are fearing of arrhythmias, and falling asleep of it, as they are not expected, your doctors considered it benign.

It is benign, but any time can modify to aggressive, so they are doing the tests frequently.

Heavy weight may be one of the causes, to supply blood to whole body it may become tachycardiac.
Wishing for a quick and complete recovery. thank you.
Above answer was peer-reviewed by : Dr. Shanthi.E
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Answered by
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Dr. Veera Raghava Rao Buddha.

General & Family Physician

Practicing since :1981

Answered : 8257 Questions

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What causes arrhythmia after swallowing food?

Brief Answer: It may be the gastro enterology problem. Detailed Answer: Hi, Welcome to Health care magic forum. You are having the problem, from the age of 15 and now 56 years.It is not diagnosed, and you are safe. You have no pain, shortness of breath, and the tests stress and echo tests not suggestive of absence any cardiac problem. Your stomach roils and it is audible through out the room, with each swallow of food, you feel the heart is feeling ectopic episodes. It most probably suggests that there is some thing related to the stomach and there might be some narrowing of the esophagus. Your neurologist didn't find any reason for this. You are using the atenolol, clonopin, hyzar, hydrochlorthiazide,levo thyroxine, phenotoin, and A.S.A. If you are using all these medicines, by prescription, do you have hypertension, hypothyroid, epilepsy, etc. All these drugs can cause the gastric irritation. levothyroxine can cause palpitations,if taken in over dose, or with out prescription. I advise you to consult a gastroenterologist , and psychologist for diagnosis and treatment. As you have I.B.S, epilepsy, I.B.S can directly cause hyper motility of the stomach. If the dose of the phenetoin is sub clinical you can have internal reaction like this. Your neurologist can find if dose is correct or not. I usually prescribe to my patient with such symptoms ranitidine, domperidone, and antacid gel, and alprazolam at night. Anemia can cause such feeling, so i advise you to verify, and use protein supplements, if iron don't use oral form, take the injections with your doctors advise if there is anemia. Take more of green leafy vegetables, pulses, sprouts, and protein rich foods to improve general health, resistance, and blood picture. Wishing for a quick and complete recovery.