The role of the stomach in Afib

My name is Sanjay Gupta and I am a consultant cardiologist and today I again wanted to talk about AF and in particular explore the connection between AF and how gastric issues could be associated with an increased likelihood of AF
We know that gastric issues are extremely common in people these days and in particular many people suffer from hiatal hernia which means that part of the stomach can protrude through into the chest cavity and as this can actually mechanically compress on the left atrium and therefore increase likelihood of atrial heart rhythm disturbances.
So there is an interesting study that I came across in the Journal of Afib form 2013 by Roy et al and what they wanted to find out whether people with a hiatus hernia have a much higher prevalence of atrial fibrillation so they looked at all patients who had a diagnosis of hiatus hernia and had been seen at the Mayo clinic in Rochester from Jan 1st 1976 to 31st dec 2006 and they also looked to see if they also had a diagnosis of AF. They then compared to this ti the reported prevalence of AF in patients of similar age and gender in the general population.
So what they found was very intesting indeed. In younger men aged less than 55 years AF was present in 3.5% of the population with hital hernia and only in 02% of the general population..I.e a 17.5 fold higher!
Similarly in women under the age of 55, there was a 19 fold higher incidence of AF compared to the general population.
Men 55-59 years 7.8 fold increase
60-64 years 5.9 fold increase
65-69 years 4 fold increase
70-74 years 2.4 fold increase
75 - 85 years 1.2 fold increase
Women 55-59 11.7 fold increase
60-64 years 5.9 fold increase
65-69 4 fold increase
70-74 2.4 fold increase
75-79 2 fold increase
80-84 1.6 fold increase
So it appears that in some way hiatus hernia is associated with increased prevalence of atrial fibrillation. However association does not automatically imply causation.. and therefore I was keen to see if there was any evidence that treating the hiatus hernia can improve Afib.
I found a few interesting case repots in the literature suggesting possible causation
Scilling et al reported a case of patient who had atrial flutter and a large paraesophageal hernia and once the patient had an operation to repair the hernia he had no more atrial flutter.
There was another case of paroxysmal flutter that didn’t respond to an even ablation but once he was started on PPIs sinus rhythm was maintained at 1 year of follow-up
I also found another case where a patient with a large paraesophageal hiatus hernia regularly developed Afib after eating found that his symptoms disappeared after he had sugery
The mechanisms by which the hiatus hernia could cause AF are 3;
1. Mechanical compression
2. Inflammation
3. Increased vagal tone from the reflux could cause AF
So I hope this was useful for you. If you found this video useful please like comment and share. Please also visit my website www.yorkcardiology.co.uk. I also have a twitter account which is yorkcardiology and a Facebook page which can be accessed by typing [e-mail]

[@BaconIsNotBiceps]

Unbelievable information. The funny thing is, I've figured out some of this on my own simply by paying attention to what I eat, how much I eat, when a-fib occurs correspondingly to what and how I eat, are symptoms made worse if I have reflux, etc. Thank you for posting this vitally important information.

[@jaybarnett5554]

I began taking magnesium which made a huge improvement but still noticed after a largr meal at night i would feel heart flutters. Im going to check into hiatal hernia. Thanks man!

[@live.remedy]

Your videos have been such a great help to allow me to understand more about heart rhythm disturbances. You have such a wonderful way of explaining and reassuring those of us who are experiencing these issues. You really are a wonderful doctor and the community is blessed to have you.

[@beyenebisrat4535]

I learned more from you than from my cardiologist thank you

[@lillinamaria]

Me too! Thanks doctor.

[@betzib8021]

Where is this wonderful doc now

[@barbaragrant9635]

Thank you for sharing this important info ... I do have a hiatus hernia, so of great interest. I've noticed something that seems to be a new symptom. If I eat to fast (I tend to eat very fast if I'm late getting a meal), or if I eat too large a meal, I get pain in my chest, and heart palpitations like AFIB but it generally goes away in a few hours. I'm about 30 lbs over ideal weight, and making an effort to lose, but it's harder at age 79. I researched and found that eating too fast or too much does engage the heart more, so now I try to avoid that pitfall. Thank you for all that you do to research and share information. It is greatly appreciated.

[@michaeltanner5058]

I appreciate all the knowledge you share for the world concerning the heart, and the stomach. Blocked gas can also cause palps. My issue is my heart beats harder or faster at night when laying down. I have difficulty passing gas, or belching, and I get bloated. I also have alot of reflux. Thank you so much.

[@bobbywall172]

Blocked gas is it for sure, after I burp a lot of times palpitations go away and heart gets smoother

[@gayfry899]

Thank you. I wish someone would have told me all this when I was in my 30's.

[@repentfast7793]

glad to see someone is addressing this issue as I do definitely have this exact issue and it really messes up my life

[@davidkrugs6466]

Hi I had the procedure done for my Afib and thought things were going to be better. But no i still have the breathing problems going up stairs or other things. My breathing gets hard and my stomach hurts . After seeing your video, I think that you are right. Got a appointment Friday with my cardiologist to discuss it. Thanks so much. Will let you know. 😊

[@dougcoleburn1579]

What did you find out?

[@PaulBeauchemin]

Interesting, all my AFIB episode’s come after eating

[@marcellenebiker7179]

it happens to me too ..so i try and avoid the worst offending foods i.e. bread, cakes, alcohol etc., if i stick to fruit and veg mostly then i'm fine.

[@ralphstadler429]

Thank you very much for this important information and I have lived the fears most of my life because nobody ever explain the stuff to me thank you!!! Your AWESOME!!!

[@dnkeyhnter690]

Glad to see the KZbin videos are back more often again

[@bumphoto]

I just found your video and I will be having surgery next week on my esophagus and hiatal hernia that no one and that includes Mayo said a thing about my strokes but preferred to put me on expensive drugs. I am more encouraged than ever to get it done. Thank you!

[@patriciabennett1819]

It is so good to have expert advice from you being a professional doctor consultant.You explain in an easy way so everyone can understand.It is valuable information which is a great help .For you to take the time to do this I am so grateful and appreciate it. Thank you for video and blessings and greetings .x

[@CutestDogSisters]

After I listened to professor Steven porges talk about the polyvagus theory....I figured after listening that eating while distracted you aren't triggering your rest and digest response...I started being fully engaged with my food....my GERD disappeared. Helps enormously.

[@tamarisk3109]

I know you wrote it 3 years ago, but maybe you will explain how did you rid of Gerd? Please!!!

[@CalmVibesVee]

Excellent teaching skills. Thank you Sir.

[@amaniketchen6669]

Very informative . Thank you so much.

[@davidhurst4577]

You always have great information! Thank-you so much!

[@smiconsulting8434]

You’re amazing doctor! Thank you!

[@rakhshindaadnan1344]

I got my diagnosis through this video today..... Thank you

[@jancovorster8154]

Very interesting, thx Dr. Your video's are always useful.

[@paulinebeaton4992]

Thankyou so much for your kindness in sharing your vast information. I have barratts oesophagus and am on P.P.I.s. I also have a hiatus hernia. I have jumping of my heart which sometimes goes up into my throat so your video has been very helpful. Thankyou again.

[@MsFishingdog]

great video.

[@josieanonymous961]

Very, very helpful, thank you!

[@lydiapereira1942]

Thanks Dr Gupta

[@tessagunputh8972]

I shall look into this. Thank you

[@marymelnyk3678]

Thank you 🙏

[@MrCarstennielsen]

Xtremely usefull.

[@swonghobby]

I have hiatal hernia and GERD, when my stomach is acting up, I get my PVC. When my stomach is good, my PVC is gone. There is certainly a link between the stomach and the heart. Unfortunately there is just not enough studies and there are no specialists that specialize in both the GI and Heart.

[@nopretribrapture2318]

Sam Wong when i had an endoscopy few years ago my stomach problems worsened, ,they saw on the monitor a lump in stomach,,they took a biopsy and discovered it wasn't stomach cancer but a hiatus hernia. .osophagitus reflux etc..I've been on 15mg lansoprazole for many years. .can't eat or drink ANYTHING without the lansoprazole (ppi ) and bicarbonate of soda occasionally. .after the biopsy and endoscopy the situation has worsened. .endoscopy has in my case worsened the situation. .i get afib occasionally, ,I'm partially disabled and incapacitated and can't do hardly any exercise but try a bit each day..hope and pray the LORD JESUS CHRIST will have mercy on us ALL and heal us..😢

[@robertboughton2059]

@@nopretribrapture2318 Get your magnesium level tested PPI cause low magnesium which cause AFIB

[@tracey1782]

I definitely found this video helpful. Amazing! Thank you. 😊

[@shashimoghe3920]

Excellent अस usual thanks

[@melodyradburn1589]

Thank you for sharing your knowledge and experience with us, your information was very interesting. I wanted to send this clip to my mum who has AF and a huge hiatal hernia. She would be extremely interested in the information, however she has hearing problems and uses the caption function, as do our Deaf community. Please review the captions on this clip as they are not correct with the spoken word and a lot of the time don't make sense. These issues are important. I would've loved to send this to mum. ☹️

[@sheenalittle4246]

Brilliant thank you

[@SM-fb1bb]

Thank you so much! I think that's what I have and my doctors fail to diagnose.

[@sherrystone3307]

thank you so much for your information

[@20891]

awesome thanks

[@pablojpadilla9460]

Thank you

[@kathrinegemmell5064]

Thankyou so much this is interesting video I was diagnosed with AF in 2009. But have for years suffered from heartburn and had a stroke in 2011 aged 48yrs

[@MsLadyBluesWorld]

Was it due to the afib? I pray you're doing better now 💕🙏💕🙏

[@marcoapdantasify]

Thank you. 👍🏻

[@anelinah8517]

Oh my God, you are God sent! I have hiatal hernia, extrasystoles thanks to it and I think I have developed either afib or atrial flutter in the last 3 years. My heart is perfectly healthy, but I do use calcium channel blockers (for my ectopics) as I'm now 4 months pregnant and my cardiologist prescribed it to me to make my symptoms less frequent. Is there any other advice how to keep hiatal hernia (and ectopics and afib) under control, at least during the pregnancy, to make it more manageable for me? Xx

[@jf2849]

Food usually makes me feel better I’m having more palpitations when fasting but i don’t know if there’s a correlation yet still trying to figure things out.

[@Fasizan]

I always get pvc and occassionally afib while im eating. Eating has become a terrible thing for me now. Perhaps i even have developed a phobia for it now. Its terrible.

[@poppybo6601]

I hear you same thing happened to me! Almost choked on my food that came up and stuck in my throat!!!

[@espjoemusic6816]

Excellent video doctor. Do you think that problems with the cervical spine can cause heart dysfunction like fast heart rate?

[@sabrinarose493]

Hi dr .. thank you for all your videos I find them to be very informative .. I’m currently age 51 and I’ve been pretty healthy . No diabetes , no high blood pressure , however I’ve noticed the past 4 years that I’ve been struggling with anxiety attacks that come out of no where and usually happens the day of and or day before I’m about to start my menstural cycle . I have these sensations that feel like an anxiety attack where it usually starts to feel like fluttering at the vagus nerve right under my breasts or at the top part of the abdomen and then it will cause my heart to beat too fast . When that vagus nerve starts to flutter per se I feel shortness of breath then like my heart starts to beat too fast and I can feel skipping in the rythm of my heart and then my nerves start to shake like an anxiety attack . I get nausea , I get headaches and so on I’m either vomiting or on the toilet . I’m dizzy and just feel so weak . All muscles hurt because they were tight. usually those feelings subside right after my mensturation starts usually that day or the next day . However the shaking inside my nerves continues . Then goes away mildly . I get that sensation again on the last day of my menstural cycle but much milder. I once was given Xanax because they thought it was grief because I saw my dad die 4 years ago but I can sit here and tell you all about it and not fall apart and all so it is not that at all . I believe it is the vagus vein nerve or whatever and something to do with my hormones yet no one is able to tell me anything except oh my hormones are messed up . Or oh my cortisol is high .. oh I have 19 nodules in my lungs and I have 9 in my thyroid so I believe all that plays a part of these anxiety sensations I get . Any suggestions on where I may look to get help I’ve spoken to an endocrinologist and they just always want to focus on diabetes and all and I don’t have diabetes . I think these dr s may not know how to treat hormones or anything . I just within this past year found out I have fluid in the sack of my heart . I have also been taking omeprazole for my heartburn for a good possibly 2 1/2 years . I know you mentioned in one of your videos about that causing a negative effect on magnesium and iron and so forth . I do have severe anemia as well and they haven’t done anything for me on that either . Maybe can you give me a bit of your knowledge and advice because I’m not getting answers in my doctors . Look forward to hearing from you thank you for your time . Sabrina Rose

[@Sand24]

Good to know that there is a correlation. People can get surgery, have it treated and not suffer🙄

[@AubrieLynnx18]

Sometimes I will get bouts of what feel like ectopics. It seems to be related to my posture /GERD but not always. I’ll have one, then quickly another, and another. Sometimes for up to 5 minutes. It between the ectopics, there are some normal beats, but not many during these “episodes”. My overall heart rate elevates as well- but i also panic when I get so many at once. My question is- how can I know if this is just an episode of close together ectopics, or a fib? I am 23 and had an echo 3 years ago that was normal, I also had two ekgs within the last year that were normal. But my ectopics have never been recorded since they’re often random.

[@351WINCHESTER]

Prior to retiring I had a big bowl or Jasmine rice with back eyed peas. The next morning I was in AFib. Could the excess food cause my A Fib?

[@WendyMoule]

My nan had hiatal hernia and afib. Nans afib was untreated and she had heart attack and stroke and died. Her son, my dad, had afib and stomach issues from mastocytosis. He died of bone cancer. I have blood allergies and PAF.

[@fadalbahou1486]

Hi dr gubta,I have contacted you about a year ago regarding atrial fib and you did answered me back thank you for that.on the 5.12.17 I went to st George's in london to have a catheter ablation i was lookig forward to it. I went under general anaesthesia but dr zia zobiri could not do the procedure as he found that i have left atrial myxoma 2cm and i am very upset and worried about this. I can't believe they never noticed it when i had an echogram about 6 mounths ago . All this time i was thinking i had paraxysmal atrial fib but everyone was wrong. I am very worried about this.

[@YorkCardiology]

Thank you so much for your comment and for watching the video. Please join me for live free chats on my Facebook page (type [e-mail] in Facebook search) - I will be able to answer your questions there

[@sosstsff1]

I have always mentioned to my Dr. that I felt myrelux and PVC were related. Now I have Afib

[@lillinamaria]

I too have always felt that my afib was stomach related as I have reflux and when I have a bad case of it, I feel my heart out of control and often go into afib. Cardiologist has always told me not to be so silly in thinking this.

[@dougcoleburn1579]

How are you doing today?

[@KennM12]

i don’t have afib that i know of. but i do notice my pvcs and pots symptoms seem to be connected to my GERD. i had an egd not long ago so i know i don’t have a hernia.

[@BothSidesNow52]

What is the treatment for hiatus hernia? I have a small one and also have Afib. Thank you.

[@jaybarnett5554]

Im taking antacid pill everyday. The kroger brand is cheap and works. That with a magnesium pill everyday i am symptom free.

[@sheradenart7907]

could, a swollen speen, kidneys, and liver cause pressure on the heart that may result in Afib and/or tachichardia?

[@roportajadam7371]

Hi I am very worried I’ve had wolf Parkinson white syndrome and had a ablation 5 months ago it was succeful I also am having this skipped beat for a few second often and don’t know if this is AFib or pvc if it’s pvc can it lead to heart failure cause I had a Echocardiogram they said it was okay and normal but I had wpw is isn’t this a birth defect and congenital heart diseases which can lead to heart failure or not please reply wehnether you can even for a month until you reply I’m so worried.

[@karthickkavith4010]

Hai I'm from india ,tamilnadu Coimbatore,I too have this problem and faced 4 times ,my heart runs 256 per minute at that time ,but it happens only wen stomach get some disturbed like heart burning or feel like it's full,but doctors not accept my words ,they told me to go for catheter ablation ,is ther any other options , please any ones suggestion

[@roportajadam7371]

I had wolf Parkinson white syndrome can you make a vidoe after a wpw recovery and heal process and AFib with wolf Parkinson after wpw ablation and reason

[@roportajadam7371]

Because I had this a year ago and had a succefull Ablation 5 months ago and still having palpitation and little irregular heartbeat and I am very worried can you make a vidoe based on wpw and my include my points cause there no proper KZbin vidoe to understand

[@jaws7794]

yea count me as 1 of the status.told my Dr bloated after only 1 meal causing my afib. he never heard of anything related in medical records. 5 yrs later at 55 still taking afib meds. maybe I should check for hernia. would rather do a lariat procedure than ablation treatment. only if not a hernia an i get to choose out of the 2..

[@venkatpujith7100]

How to talk with you bro please reply

[@MelissaLopz]

👍🏻👍🏻👍🏻👍🏻👍🏻👍🏻👍🏻👍🏻👍🏻👍🏻❤️

[@LIBlurr]

Wow I get arythmia in early morning when I eat late night snacks, resulting in sour stomach too... i also have an inguinal and a slight little hiatal spot around belly button. What to do??

[@namelessanonymous5216]

Is an endoscopy the only way of diagnozing a hiatus hernia?

[@jackiefearnley8554]

Mine was discovered with a barium swallow and I notice the same for a couple of other people.

[@swonghobby]

Speaking of Anti acid medication and PPI, when I take too much, by too much meaning in a longer length of time such as over a week, I start getting PVCs. I guess when my acid is too low, I get PVCS. As a matter of faces, the PVCs are worst when my acid is low vs high.

[@robertboughton2059]

PPI CAUSES LOW MAGNESIUM TEST YOUR MAGNESIUM TAKE IV MAGNESIUM

[@ASpectacular3777]

I have a moderate Hiatal Hernia and developed AFib afterwards. Now I need to have Catheter Ablation this Feb 14, 2024. I don’t want surgery. Shall I try to lose some weight. I’m only slightly overweight by 8-10 pounds but have a very small frame so maybe it harms me more…this slight weight gain.

[@suenewberry7330]

My Afib is always accompanied by burping. I suspect hiatus hernia but the GI doc said he couldn’t tell if I had one when he did the endoscopy. He said it didn’t matter!

[@piroskamerk106]

Sue Newberry My hiatus hernia was discovered when I had a barium steady 🤗

[@piroskamerk106]

Sue Newberry sorry I misspelled. I had a barium study I had to drink that withe things than I had a X Ray. And find the hernia. Not with the endoscopy. I had before but they didn’t picked up. 🤗

[@tamarisk3109]

I have the same

[@MrCarstennielsen]

Listening to your vids in bed. Great.

[@guygranger7894]

There`s a world of folks out there that are between 50 and 85 that are diagnosed with A-fib.. why did the study skip over them?

[@poppybo6601]

Is it hiatal or hiatus?? It has to be hiatal.

[@-questrienne-7162]

Hiatus is the site at which the hernia occurs; hiatal is the adjective form of hiatus, used to describe the hernia.

[@paxbritannica5598]

Doctor I am an example of one of these patients. I have been diagnosed with GORD confirmed by monitoring the pressure of LES with manometry and 2 endoscopy showing inflammation of the oesophagus. I’m 24 and otherwise healthy. I don’t smoke and drink very little, body type lean/average. I have dizziness, breathlessness, chest pain, lightheadedness and anxiety almost every day. There is no reason for anxiety, it is genuinely as though the physical symptoms of refulx have changed my brain. My stress/fear response is so intense for no reason. I’m certain my heart or some nerve is irritated by the contents which are in the oesophagus. I just wish anyone in the NHS would listen to me. These are atypical symptoms of gord and unfortunately not many doctors are aware of any of this stuff. I would love to see you, i am in North East of England 1 hour from York. I have had this for 2 years and feel like my life is over. Thanks for the videos and for giving hope to the hopeless.

[@simasp7189]

S H I can relate to you. I suggest you to consider a possibilty of mast cell activation syndrome. Lookup Dr. Lawrence Afrin. He has a book on amazon. Good luck.

[@syedaftabhaider39]

weldone but u are not answer my question i have palpitations 100 per minute my bp 130 / 80/ 70 i am on antenolol tenormin 50 mg take one daily is it ok

[@dnkeyhnter690]

AFTAB TECHNICAL take Magnesium Taurate as well

[@jackschultz6673]

My Dr won't let me have surgery on hernia. I have worked hard all my life.. doing alot of heavy lifting. I worked construction.... I had an ablation but still don't feel real good... I have had reflux for years..... Meds don't help no matter what I eat.. if I over eat the when go to bed heart beating in chest bad gas bloating can't sleep restless fluttering..etc....on metroprol... Going back to Dr. In two weeks....r toss and turn can't sleep alot....

[@ericschulze5641]

June 2022 I began having a afib but have had digestive issues many years, what have you found out since you posted this message ?

[@AP-vn7fm]

Whay is afib?

[@maryseeman8528]

Burps will often set off an episode.

[@bi2305]

why do I feel pulse in stomach! I read it is really dangerous.it has mad my life extremely miserable.

[@Rene-uz3eb]

Well the paper shows a giant hernia that clearly is right next to the atrium. But in another video you say that eating is a common trigger for afib, and I didn’t hear a qualification of hernia there. Those numbers (17x) sound too arbitrarily extreme. You only find case reports of giant hernias wrt afib, like this: Paroxysmal Postprandial Atrial Fibrilation Suppressed by Laparoscopic Repair of a Giant Paraesophageal Hernia Compressing the Left Atrium, 2015 Strangely the Roy paper doesn’t show up, case reports preferred on google scholar, if I don’t type the author. Their hospital data says that 7% of the HH population had afib, with average age 73. That sounds like a very normal afib proportion for old people, since afib is extremely common with age. It sounds low actually. Over 65s are supposed to have 10% afib. Nobody else is claiming to show that hernia results in a significant increase in afib, other than the Roy paper. There is a very slight increase (risk 1.1 or so) for Gerd. Hospitalized people will have higher incidence of any disease/comorbidity, vs a general healthy population. If you want to do proper risk analysis you need to look at a common population and check how many have hernia, afib, or both. Which they could have done with their hospital data so I don’t know why they would compare to a general population statistic. This study is done wrong. I would say deliberately, because it’s obvious to compare the rate of afib in the hernia population vs afib in the no-hernia population in the same dataset. This paper is a scam: Ranjini R Roy et al, Hiatal Hernia Is Associated With an Increased Prevalence of Atrial Fibrillation in Young Patients, 2013