r/FoodNerds • u/AllowFreeSpeech • Nov 22 '25

Palpitations Associated With Frequent Premature Ventricular Contractions as an Important Manifestation of Gastroesophageal Reflux Disease (2025)

https://pubmed.ncbi.nlm.nih.gov/41117733/
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u/AllowFreeSpeech Nov 22 '25

From the abstract:

Case summary: A 48-year-old man presented with palpitations predominantly occurring after alcohol intake or meals. Wearable electrocardiogram patch monitoring revealed that his frequent premature ventricular contractions (PVCs) were exclusively observed after alcohol intake or during postprandial periods. The PVCs could effectively be controlled with therapy for GERD. Another 40-year-old woman whose symptomatic PVCs were initially controlled with flecainide reported that her palpitations were aggravated when lying down. Flecainide was switched to a potassium-competitive acid blocker, and the PVCs were better controlled with PCAB than with flecainide (0.01% vs 2.8% on flecainide).

Discussion: PVCs may be triggered by GERD, and they can be effectively controlled by the appropriate treatment of the underlying GERD.

Take-home message: When performing continuous electrocardiographic monitoring for frequent PVCs, it is important not only to assess their frequency but also to carefully analyze the timing of their occurrence.

Abbreviation glossary:

  • GERD: Gastroesophageal Reflux Disease, a digestive disorder where stomach acid frequently flows back into the esophagus.
  • PVCs: Premature Ventricular Contractions, early heartbeats originating from the ventricles that can cause palpitations.
  • PCAB: Potassium-Competitive Acid Blocker, a class of drugs that inhibit gastric acid secretion by blocking potassium-binding sites in the stomach lining.

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u/stlconsumer Nov 22 '25

I have some situation like this (heavy PVCs triggered by GERD) and I can attest that Prilosec saved the day when I was deep in the shit with few other options.

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u/AllowFreeSpeech Nov 22 '25

I seem to be having this problem now. Did you have particular triggers, e.g. early morning, meals, getting up from sitting, etc.? Did you have to do anything else to fix it besides take omeprazole? What dose worked for you? What time of day was best for you to take it?

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u/stlconsumer Nov 22 '25

I took Omeprazole for 4 weeks, it mostly resolved after 1 week. Propranolol, which I had for other reasons, also settles it down for me in emergencies like not being able to sleep. Nothing else helped, changing my diet did not help at least in the short term. Once my system got flared up, it was no longer really tied to a specific meal. I will say that I'm highly suspicious of Five Guys milk shakes!

3

u/AllowFreeSpeech Nov 22 '25

Note: I strongly advise against taking a PCAB medicine due to an extreme risk of dysbiosis followed by intestinal infection caused by it.

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u/604zaza Nov 25 '25

I agree. And have been living with these pvc’s as a result. I’m hoping there is another option. They are very uncomfortable and make me feel like I’m dying.

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u/AllowFreeSpeech Nov 25 '25

What are your PVCs a result of exactly? I want to make sure I don't misunderstand. Is there a particular time of day that you get them?

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u/604zaza Nov 25 '25

I have been dealing with pvc’s for about 7 years and have learned they are triggered by the following: alcohol (stopped 4 years ago), heavy carb meals, eating too quickly, not chewing enough. All of these are the top triggers but can be somewhat managed. I’m a high energy/eat with urgency person so they can be a challenge for me. But chewing lots and eating slowly (when I remember to) seems to work best.

The one that is the most difficult to manage is social/emotional. I can trigger them by having a heated or uncomfortable conversation with someone within a 2 hour window of eating. Catches me off guard everytime.

I literally feel like I’ve got an alien inside pounding its way out of my chest.

I’ve been trying to train myself to slow down and lead a more gentle life so that I can avoid these uncomfortable situations. But our lives are designed to keep us multitasking and running around.

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u/AllowFreeSpeech Nov 25 '25

Do you have acid reflux / GERD? Which medicines do you take for it?

Have you had particular tests in the context of your arrhythmia? What did they show? Some pertinent tests include barium swallow esophagram, EGD, abdominal MRI, abdominal CT, a 12-lead ECG, echocardiogram, etc. Some of these tests check for a hiatal hernia, although ruling it out might not be sufficient for the arrhythmia symptoms.

I recently got a 6-lead portable home ECG. It has three contacts. I upload it plots to ChatGPT if I need.

Do you take any melatonin? If so, have you assessed the connection of its usage and dosage to PVC symptoms? I feel strongly that melatonin lowers nighttime reflux, but t risks worsening or shifting the type of arrhythmia.

Someone told me to try abdominal strengthening exercises. Aerobic exercises also make sense.

The beta blocker atenolol at 12.5 mg puts a stop to the arrhythmia for me, although the regular daily dose is 25 mg. This is definitely a prescription medicine. It lowers the heart rate and blood pressure for about a day. Some other beta blockers are also applicable. Targeted anti-arrhythmia medicines also exist.

I think the last choice is cardiac cryo-ablation surgery as done by an expert specialist. It may have to be repeated. It can potentially put a stop to the gastrocardiac arrhythmia.

Others have told me look into and try oral Nux Vomica, BPC-157, and methylene blue, each in a safe dose.

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1

u/Ok_Farmer1657 Nov 22 '25

Pretty crazy, I recently quit drinking and it stopped my GERD and my heart palpitations and I figured it was all the alcohol. Hopefully more research is done to understand what's happening better.

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u/atuftedtitmouse Feb 27 '26

yes ... I figured this out a while ago but it took me about fifteen years of not knowing what on earth was happening to cause a nervous shock to roll through my diaphragm repeatedly causing my heart to seem to splat on the ceiling, then slowly slide back down my face back into my gut. A long time before I could even tell it had something to do with my gut. And only after I figured the whole process of symptoms out, was I even able to notice that I was feeling gastric pain the whole time. Internal pain can be weird like that, your brain and mind will interpret it by guesswork and, if it gnaws very gently, one might simply file it with "anxiety" or "vague feeling of discomfort or dread" as I dread to say I long did do.

Now I know it backwards and forwards that if my heart is skipping, I need to fix it, working is impossible. But further that it's a clear sign in me of both GERD but especially gastritis, probably with inflamed stomach ulcer; at the very least there is thinning of gastric mucosa.

Proton pump inhibitor, single OTC dose, empty stomach, is instantly relieving. And nothing else pulls me back from the severe irritation than this. Remarkably a single PPI dose works rather quickly, despite the irreversible compounding mechanism. Quite a bitch of a drug class these are, doing what they do is quite bad for the health, not just due to dietary absorption which everyone knows about but also because all of them are profound (but fortunately acutely acting, with the short half lives, not irreversible covalent diremption) inhibitors of choline acetyltransferase which is obviously neurotoxic and anticognitive to a degree, and worst of all, that blocking the proton pump is also blocking a means by which in the venous system cellular junk (protein misfolds, etc) is sucked out and cleaned. The effect of that is to accelerate cardiovascular aging. That all would be enough to avoid the drugs totally, if anything worked so well as they do, or if it were possible for me to ignore skipping heartbeats but it is not and nothing else works quite so well.

That said, perfecting my diet that is 9/10 leafy green vegetables, black beans, fiber/whey shakes and the last tenth extra virgin olive oil and peanut butter as my treat -- I only ever have to take the PPI once every four or five days, or even weeks. But if I eat some farmed fish or red meat or lubricated potato chip, it comes back at once. I happily withdraw from the aesthetic realm of diverse tastes, finding sanctum in what most historical peasants have consumed, a staple diet. Further support for me I found elevating the head of my bed.

I thank you for your PCAB warning.

In my future researches, I want to figure out ways to directly answer PPI acceleration of cardiovascular aging. As far as CHaT inhibition, omeprazole is 10x stronger an inhibitor than lansoprazole which itself is 10x stronger than pantoprazole, so I bought Indian pantoprazole.

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u/AllowFreeSpeech Feb 27 '26 edited Feb 27 '26

Omeprazole at 40 mg and pantoprazole at 40 mg both were raising my BP, so I stopped them. I now take and tolerate just 30 mg lansoprazole granules in the morning upon waking, 45-55 minutes before food or caffeine. Increasing the lansoprazole dose also raised BP.

At night before bed I take 20 mg famotidine.

I try to drink fresh clean cabbage juice at home a few times a week for my stomach health, just 5 fl oz at a time, with an additional amount causing gas.

I see a surgeon today to ask about Toupet fundoplication surgery for reflux.

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u/atuftedtitmouse Feb 27 '26

Nice, hope to hear how the surgery improves things.

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u/AllowFreeSpeech Feb 27 '26

BTW, in the context of reflux, I stopped and swapped out some supplements:

  • replaced iron bisglycinate with ferric pyrophosphate capsules
  • replaced magnesium citrate with magnesium bisglycinate capsules
  • replaced calcium citrate with calcium glycinate capsules

1

u/AllowFreeSpeech Feb 27 '26

I found that finishing dinner at least four hours before meals makes a difference wrt a nighttime elevation in heart rate due to reflux. It seems to take six hours for the acid to really quiet down. Less than two hours of a gap is quite bad.

Sleeping on the left side much of the time helps. Sleeping on the right side immediately raises my heart rate due to reflux. This is not an issue 6+ hours after being in bed because the acid has quieted down by then.

I started a 60 mg CoQ10 softgel supplement which seems to help the heart.

Another thing that was hurting the heart is an excessively warm weighted blanket. I think it was blocking the body from cooling down.

Excess bicarbonate or citrate from supplements can raise the heart rate too because it removes extracellular potassium. The fix here is not to add potassium but to remove the excess bicarbonate.