Dr. Hive - Severe Heartburn, Heart Palpitations, Other Strange Symptoms - Updated 9/8 With Diagnosis and Treatment

[JumpyTheFrog]

A month ago DH (late 30s) woke me up because he wanted to go to the ER. He had gone to the bathroom and after going back to bed noticed his heart was pounding. He used the pulse oximeter and his pulse, just lying there, was something like 140. His oxygen was fine. The ER did a CT scan and his heart looked good, bloodwork was normal, EKG was fine, and his chest x-ray was clear. He did a Covid test after being sent home and it was negative. They gave him a heart monitor that he wore for two weeks. When he went to the cardiologist last week, he hadn't received the results.

I had him write up his symptoms.

Quote

Symptoms:
* Chronic heartburn starting on June 12 and persisting most days after breakfast, sometimes it subsides before bedtime, a few times it has lasted past 2am
* Trouble breathing: Taking a deep breath is slightly unfomfortable, like my ribs shrank a little compared to normal. Get winded much more easily than normal when performing physical activity. Shortness of breath
* Gnawing pain in my stomach, even when no food in my stomach. Intermittently wakes me up in the morning between 4-6am with stomach pains/spasms.
* Much more muscle twiching than normal, mostly in arms and chest
* Weird pains that feel like they're coming from my ribcage. A lot of times in the center near breastbone, but a few other places as well (behind right nipple, to the left of my left pec, bottom of left ribcage). Stretching helps to alleviate them, or massaging the area
* Can sometimes feel heart beating during normal situations

We were thinking reflux and maybe an ulcer, so the PCP ordered an H. Pylori breath test. It came back negative. The GI doctor ordered an endoscopy, so he's waiting on that to see if he has an ulcer. Before this happened he never had a problem with reflux except for occasional minor heartburn if he ate ice cream before bed.

He's been taking Prilosec twice a day, which is helping. Eating ice cream with every meal also seems to help sooth his stomach. He read about eating lots of cabbage to treat ulcers and it seems to be helping some as well. However, last night and the night before he had the pounding heart/palpitations again. Last night it started after he woke up in pain from his stomach.

Does anyone have any ideas what might be going on other than H. Pylori, an ulcer, and reflux? The symptoms don't really seem to match gall bladder symptoms I've seen on lists, and he doesn't have any tenderness in his abdomen like is apparently expected with appendix stuff.

Edited September 8, 2021 by JumpyTheFrog

[TravelingChris]

Has he been taking ibuprofen or aleve regularly?  As I had rheumatological diseases, I was prescribed prescription NSAIDS and after a number of years, developed esophageal spasms that feel like a heart attack.  Had to stop all NSAIDS forever.  

[catz]

Has he tried probiotics?  Dairy feels good in the moment, but it can actually make reflux worse overall.  SLOWLY adding fiber (preferably something gentle and natural like ground flax) and probiotics can help over time.  I'd also encourage good exercise, balanced diet, stress management, sleep.  Avoid processed sugar and white carbs.

I actually had something similar.  I had a small ulcer.  I was diagnosed w/reflux and IBS.  I have managed it pretty holistically for years at this point.  

Edited July 19, 2021 by FuzzyCatz

[JumpyTheFrog]

21 minutes ago, TravelingChris said:

Has he been taking ibuprofen or aleve regularly?

No, he hardly ever takes any pain relievers.

 

19 minutes ago, FuzzyCatz said:

Has he tried probiotics?  Dairy feels good in the moment, but it can actually make reflux worse overall.  SLOWLY adding fiber (preferably something gentle and natural like ground flax) and probiotics can help over time.  I'd also encourage good exercise, balanced diet, stress management, sleep.  Avoid processed sugar and white carbs.

I actually had something similar.  I had a small ulcer.  I was diagnosed w/reflux and IBS.  I have managed it pretty holistically for years at this point.  

He just started probiotics and some fiber supplements. He eats too much sugar.

[JumpyTheFrog]

Before this started a month ago DH was playing soccer twice a week and lifting weights several days per week. Now walking around the neighborhood sometimes leaves him feeling out of breath.

[itsheresomewhere]

5 minutes ago, JumpyTheFrog said:

Before this started a month ago DH was playing soccer twice a week and lifting weights several days per week. Now walking around the neighborhood sometimes leaves him feeling out of breath.

Did he see a cardiologist or was it his pcp who reviewed the results?  If it was his pcp, he needs a cardiologist to take a look.  And has he seen Pulmonologist?

[JumpyTheFrog]

The cardiologist didn't have the heart monitor results yet at the appointment last week, but he seemed to think the chest area pain was related to the sudden severe reflux issues. As DH got the reflux under a little better control he had noticed that the pain was more in his esophagus and stomach area, near his heart, but not his heart. When the pain was worse he wasn't able to pinpoint it, which is why he thought it might be his heart. Until two nights ago, DH hadn't had any more palpitations since this all started a month ago. 

Last week he had a day when he didn't really have any heartburn. That day he was able to breath much better. He thinks his shortness of breath is his lungs getting irritated by the reflux. He hasn't seen a pulmonologist.

[ktgrok]

2 hours ago, JumpyTheFrog said:

Before this started a month ago DH was playing soccer twice a week and lifting weights several days per week. Now walking around the neighborhood sometimes leaves him feeling out of breath.

Two thoughts - 

he needs an echocardiogram due to shortness of breath

could be a hiatal hernia that is trapping a bit of stomach from time to time. Hiatal hernia makes reflux worse, but in my experience can also cause weird chest feelings that are hard to explain. And if too much of the stomach ends up above the diaphragm that can put pressure on the lungs. Also, the vagal nerve is right there, so could be irritating it which would cause rapid heartbeat possibly. 

Endoscopy plus upper GI series to look for hiatal hernia (mine is only visible when they tilt the table down...then I heard both techs gasp and one say, 'wow...that's a lot of reflux!". 

If that doesn't answer it, push for an echocardiogram - it is the only way to see the heart actually functioning. Cardiomyopathy can cause changes in heart function before you see much of a change in heart size. 

But my money is on hiatal hernia. Especially if he was being a typical guy and holding his breath while lifting weights...that's one way to give yourself one. (labor is another...that's how I keep getting them! had one repaired, had another kid, now have one again)

[stormy weather]

I just had something similar last fall. I have had heart burn for years.My heart started skipping beats and I thought the prilosec or ranitadine was causing the skipping beats. The Dr. had me set up with a heart monitor and an upper endoscopy. Both showed no problems. I had already gotten a wedge pillow which has helped with the heartburn and I try to only take 10mg of ranitadine. We ultimately decided that my body was reacting to all my stress. My brain and body were in a feedback loop. I was stressed so my body was reacting to that, which in turn signaled my brain that I was in a stressful situation, repeat ad nauseum. I started escitolopram for anxiety and was given propanolol to regulate my heart rate when I am extra stressed. I mostly don't have any skipped beats now. I have noticed a correlation between taking more heartburn meds than normal for a few days and skipping heart beats. Could be my imagination. But taking the anxiety meds have helped me lower my overall stress levels. 

[Clemsondana]

I had many of the same issues (except the heartburn) and they cleared up after I got my allergies under control...it was dramatic enough that I asked the allergist if the medicines could possibly be covering some other ailment.  A friend had horrible reflux and other issues and it turned out to be an allergic response, too.  She had lost tons of weight trying elimination diets and being unable to eat reasonable portions and having all sorts of scopes when a nurse told her to get tested for allergies.  It was treated mostly with shots, and I don't think the allergies were food allergies.  I've actually known 2 teens to have problems swallowing and it turned out to be esophageal spasms due to allergies.  

I hope you get it sorted out.  For me, the allergist was the first stop on what I thought would be a series of specialist appointments - I figured that at least I could feel better while dealing with all of my weird symptoms.  I was thrilled when fixing that problem actually cured the rest.  

[Shelydon]

For reflux, dairy generally makes everything much worse. I would ask him eliminate caffeine, all soda and as much sugar as possible.  Check for hernia. 

[Kanin]

Agreed that dairy covers up reflux problems temporarily, but it makes the problem worse. A close friend of mine had horrible heartburn for years, and it went away completely after eliminating gluten and dairy (ordered by doc). After a year or two I think he went back to eating anything, and the problem has not returned. Worth a try for a couple weeks. 

[The Governess]

You might want to have him try taking a magnesium supplement. I like Natural Calm. It could help with a lot of the symptoms he is having: heart palpitations, muscle spasms, digestive issues, and just general stress/anxiety.  I think that acid reflux meds make it harder for your body to absorb magnesium also, so a supplement would be good anyway. 
 

[Roadrunner]

Pancreatic enzymes can help with heartburn.

 

[Carrie12345]

I hope all the big tests rule out the most serious possibilities!

I do get many similar symptoms when my anxiety is near its peak. I’ve even gone to the ER twice for it, the second time knowing it was likely anxiety, but I’m also anxious about how women are so likely to ignore heart attacks, so there’s a real loop!

 I occasionally get some premature ventricular contractions that I can feel when under stress. That was finally caught on an ekg strip, so I no longer feel crazy. I have done/am working on all the recommendations that can be found online for PVCs. They’re basically all the things everyone should be doing for their bodies, so there’s no real harm in implementing them regardless of whatever else May or may not be going on while waiting for answers.
 

“How can you care for yourself at home?

Limit caffeine and other stimulants if they trigger premature heartbeats.

Reduce stress. Avoid people and places that make you feel anxious, if you can. Learn ways to reduce stress, such as biofeedback, guided imagery, and meditation.

Do not smoke or allow others to smoke around you. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.

Get at least 2½ hours of exercise a week. Walking is a good choice. You also may want to do other activities, such as running, swimming, cycling, or playing tennis or team sports. 

Eat heart-healthy foods.

Stay at a healthy weight. Lose weight if you need to.

Get enough sleep. Keep your room dark and quiet, and try to go to bed at the same time every night.

Limit alcohol to 3 drinks a day for men and 2 drinks a day for women. Too much alcohol can cause health problems. If drinking alcohol causes more premature heartbeats, do not drink it.

If your doctor prescribes medicine, take it exactly as prescribed. Call your doctor or nurse call line if you think you are having a problem with your medicine.“

P.S. Most of my major bouts with anxiety have no obvious trigger, so don’t rule it out just because there’s not an obvious issue. I rarely go over the cliff when I know what’s bothering me!

 

[Katy]

My DH had to stop eating onions, anything with corn syrup, and popcorn to help.  And he says he doesn’t get reflux if he loses weight, but it’s nonstop if he lets himself get ten pounds heavier. 

[BlsdMama]

15 hours ago, JumpyTheFrog said:

Before this started a month ago DH was playing soccer twice a week and lifting weights several days per week. Now walking around the neighborhood sometimes leaves him feeling out of breath.

Heart palpitations and breathlessness can both be brought on by low iron/low B12.  It's the only idea I have but you'd know pretty quickly. 
A week on this:
https://www.amazon.com/Ancient-Nutrition-Nutrients-Blood-Builder/dp/B07NH8BNVX
would tell you if that's it.  It has methylcobalamin, iron from a good source, and methylated folate.

Edited July 20, 2021 by BlsdMama

[JumpyTheFrog]

Here's another strange symptom DH just noticed: talking makes the pain worse. He often tends to sing for hours a day while he works and yesterday he noticed that the return of his singing made him feel worse. Last night he decided he would try talking the bare minimum to see if it helped. Today he noticed that a five minute call with a coworker increased the pain.

[ktgrok]

1 hour ago, JumpyTheFrog said:

Here's another strange symptom DH just noticed: talking makes the pain worse. He often tends to sing for hours a day while he works and yesterday he noticed that the return of his singing made him feel worse. Last night he decided he would try talking the bare minimum to see if it helped. Today he noticed that a five minute call with a coworker increased the pain.

If he has esophogeal spasms, swallowing makes them worse. Not sure if he swallows more if speaking/singing?

Or is he taking deeper breaths, which would be more diaphram/hiatal hernia?

Or has a higher need for oxygen when talking, and heart can't keep up?

[JumpyTheFrog]

Diagnosis: SIBO (small intestine bacterial overgrowth)

DH had an endoscopy which showed some inflammation but was otherwise clear. H. Pylori was ruled out. While waiting for a follow-up appointment with the GI PA we ordered (through UltaWellness and DirectLabs) tests for candida, autoimmune gastritis, and SIBO. While waiting for his appointment he began following a low-FODMAP diet and found it helped quite a bit, especially with the bloating that he hadn't really noticed before because the reflux and stomach pain was so bad. The SIBO breath test came back positive for both hydrogen and methane (hydrogen sulfide wasn't tested), so he'll begin rifaximin once insurance approves it. He's also going to stay low-FODMAP for a months, take probiotics after, and take some other supplements that he's read about online to improve gut motility.

[JumpyTheFrog]

DH has lost 15+ lbs in about 6 weeks, which he is happy about. His dad said, "Of course you weigh less. All that hydrogen is making you more buoyant!"

[TravelingChris]

I am so happy he has a diagnosis!

[JumpyTheFrog]

DH just finished his two week course of Xifaxan. He will continue the low-FODMAP diet and begin some herbal antimicrobials. The Xifaxan (an antibiotic that isn't absorbed much and mostly stays in the GI tract) was going to be $1800 (that was after shopping around using GoodRx)! I found a blog that linked to the manufacturer's website. It had a coupon for insured patients. We didn't know what to expect because the info about how much it would save was very vague. We were very pleased that it brought the price down to $547. So always make sure to check the manufacturer's website for coupons for expensive drugs.

Anyway, DH started to very slowly feel a little better each day around day four or so. He still has some symptoms, such as pain around his esophagus valve and noticing his heartbeat more than before, but the shortness of breath is gone, and he is exercising again.. He is glad the GI physician assistant he saw was willing to test and treat SIBO, but he is annoyed that it felt like he and I were the ones doing most of the investigative work trying to figure out what the problem was. Too many people seemed to just shrug and say, "Well, you're getting older, so take some reflux drugs." 

[goldberry]

My BIL just had surgery for hiatal hernia last week due to very similar symptoms.  He is very active and his exercise has been disrupted for the last two years with heart palpitations and breathing problems.  After having all kind of heart tests, etc. they finally pinned it down to the hiatal hernia.  Really strange, I never knew it could cause those symptoms.

[ktgrok]

1 minute ago, goldberry said:

My BIL just had surgery for hiatal hernia last week due to very similar symptoms.  He is very active and his exercise has been disrupted for the last two years with heart palpitations and breathing problems.  After having all kind of heart tests, etc. they finally pinned it down to the hiatal hernia.  Really strange, I never knew it could cause those symptoms.

The vagus nerve runs right by the esophogus, so the hernia can press on it and cause vagal reactions - that's the source of the heart palpitations likely. And the breathing can be from either acid refluxing into the lungs, or from the hernia actually taking up space in the chest cavity, or irritatin the diaphragm so it isn't functioning right.