Doctors Lounge - Gastroenterology Answers
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Forum Name: Gastroenterology Topics
|aaronflux - Tue Mar 31, 2009 1:01 pm||
My mother is almost 62 years old. 7 Years ago she was diagnosed with a hiatal hernia after having a pretty bad attack that included nausea, vomiting, dizziness, and elevated heart rate. She changed her diet per her doctor's request.
Recently she has been having irregular heart beat issues. They happen as episodes mostly at night after going to bed. She wakes up feeling light headed and dizzy along with a rapid heart beat and sometimes nausea. We had to admit her to the hospital about two months ago as it was pretty bad. The EKG showed an irregularity and the doctor ended up diagnosing her with a Supraventricular Tachycardia. They put her on Atenolol and Aspirin for the heart.
She has still been having random spells, still mostly at night after going to bed. I have found online a bunch of material suggesting there is a connection between the light headedness and elevated heart rate/irregular heartbeat and the hiatal hernia. We were at the ER again this past week and the doctor there agreed. However, her heart doctor and regular doctor both laughed that off saying it wasn't possible and they want her to have a procedure done called an "Ablation" to fix the tachycardia.
She has set up an appointment with a gastroenterologist before deciding to go through with this procedure. The ER doctor gave her Ativan to help with the anxiety and panic that happens during an episode to help calm her down. But aside from all this, I would really like to know if the hernia and heart symptoms can be connected. I've read the hernia could put pressure on a nerve that would cause the symptoms of tachycardia to happen. If this is the case, should she have surgery to fix the hernia and if so, would it possibly fix the other problems as well? Recent EKG, blood work, urine test, stress test, and CT scan of the head all came back fine.
|John Kenyon, CNA - Tue Apr 21, 2009 11:04 pm||
This one isn't as difficult or complex as it sounds. First, yes, there can be a connection between hiatal hernia (or other GI problems) and while the underlying cause is sometimes separate from the GI problem, those can aggravate various sorts of arrhythmias, especially in terms of bodily position. So lying down to go to sleep, or horizontal posture, can sometimes, due to anatomical anomalies like hiatal hernia, aggravate certain arrhythmias. In fact, this is pretty common, especially in terms of premature ventricular beats (PVCs). It can also help trigger independent SVT.
Now then: hiatal hernia is rarely repaired surgically, although in certain very severe cases (severe in terms of anatomical features, not necessarily measurable by symptoms alone) it may be. Usually doctors would prefer to not try and correct it but rather treat the symptoms.
As for the SVT, if it is persistent, recurrent, or long-lasting, it should be subject to an electrophysiology (EP) test, with an eye toward ablation of the irritable focus that allows it to happen. This is an almost certain cure 85-90 per cent of the time, and even if the hiatal hernia is helping to trigger it, if it is successfully ablated it will most likely not happen anymore. The success rate is generally excellent, and while no invasive procedure is ever totally risk free, this one is a very low-risk one, an in-and-out deal usually, at most keeping the patient over night if it's not done early in the day.
So then: conclusion: Hiatal hernia may be aggravating the problem; hiatal hernia is very rarely considered worth the surgical risk for repair; and SVT often is totally curable via radio frequency ablation in the course of an EP study. If this is done the chances are it will be gone for good.
I hope this helps answer your concerns. Please follow up here if you have any further questions or concerns. I think your mother would probably do very well to have the EP study with possible ablation. Good luck to you both.
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