heart disease Archives - York Cardiology

The connection between atrial fibrillation and the stomach

By | Atrial Fibrillation, cardiology, heart disease | No Comments

Today I again wanted to write about atrial fibrillation (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.

There is an interesting study that I came across in the Journal of Afib from 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. 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.

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 hiatal hernia and only in 02% of the general population..I.e a 17.5 fold higher!


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

Similarly in women under the age of 55, there was a 19 fold higher incidence of AF compared to the general population.

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 AF.

I found a few interesting case reports in the literature suggesting possible causation.
Schilling 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. Here is a link to my video on this subject




Symptoms Of Unstable Angina

By | heart disease | No Comments

You may experience symptoms of unstable angina after previously having symptoms of stable angina. Stable angina or typical angina pectoris is the most common form of angina. Unlike stable angina, unstable angina can occur without physical exertion and is not relieved by rest or medicine. Stable or silent angina is the most common form of angina in the elderly, and it occurs in an identifiable pattern. There are several different types of angina characterized by the timing and duration of symptoms. Stable angina is the most common form of angina and typically occurs with exertion and goes away with rest.

Chest-Pain-240x224Unstable angina is considered to be an acute coronary syndrome in which there is no release of the enzymes and biomarkers of myocardial necrosis. The biomarkers of necrosis are below the threshold of myocardial infarction. During unstable angina, no enzymes and bio markers of myocardial necrosis are released during unstable angina thereby making it to be an acute coronary syndrome. Several symptoms can help you discern the presence of unstable angina. There is insufficient population-based data describing the prevalence of acute myocardial infarction in sub-Saharan Africa. There is a form of angina called cardiac syndrome X.

Angina is due to a temporary reduction in the flow of blood to part of the heart muscle and does not damage the heart itself. A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. Because of the decreased flow of blood, there is not enough oxygen to the heart muscle resulting in chest pain. Angina can be caused by an insufficient supply of blood and oxygen to the heart muscle. The pain is a result of an area of muscle surrounding the heart that is not receiving enough oxygen. The pain is caused by inadequate blood supply to your heart, which leaves your heart deprived of oxygen.

A heart attack is a prolonged decrease in oxygen to the heart that results in permanent damage to the heart. Certain heart enzymes slowly leak out into your blood if your heart has been damaged by a heart attack. An attack of angina does not cause permanent damage to the heart muscle. When certain ECG findings are present, the risk of unstable angina progressing to a heart attack is significantly increased. Where a heart attack threatens to lead to permanent damage to your heart muscle an angina attack is not. People with untreated unstable angina are at high risk of a heart attack or death.

Chest pain is the most common symptom of angina and is often described as a feeling of tightness or as a heavy weight on the chest. The classic chest pain from angina feels like significant pressure, squeezing, or tightness in the center of your chest. The chest pain associated with angina pectoris is described as squeezing, pressing, burning, choking, or bursting felt along the sternum. The pain may feel like tightness, heavy pressure, squeezing, or crushing pain. Angina presents itself more as a chest discomfort, rather than frank pain, which is described as pressure, heaviness, tightness, squeezing, burning, or choking sensation. Because of the seriousness of the disorder, anytime someone has pain in the chest, it is ascribed to angina.

Red-Broken-HeartAtherosclerosis is the buildup of fatty material called plaque along the walls of the arteries. Angina occurs when one or more of the coronary arteries become narrowed or blocked. Resting angina may occur as a result of plaque buildup in the arteries causing a coronary spasm. The coronary arteries can become narrowed by a gradual build-up of fatty material within their walls. Variant angina occurs when there is a narrowing of the artery due to a spasm. The balloon is inflated and deflated, pressing against the plaque buildup on the walls of the coronary artery and increasing the diameter of the artery.

Angina is one of the symptoms of coronary artery disease. Recent research has linked periodontal disease with the risk of coronary artery disease and stroke. One of the most characteristic and troubling features of coronary disease is the sudden and unexpected onset of symptoms in clinically stable patients and sometimes in even previously healthy individuals. Patients with rapid progression of atherosclerotic disease at multiple sites experience unstable angina more frequently. The angina symptoms are a result of coronary heart disease. Because heart disease is often the cause of most forms of angina, you can reduce or prevent angina by working on reducing your heart disease risk factors.