Roemheld Syndrome

Don't know if anyone has experienced this with their GERD but Just thought I would share this with you, as I was convinced I had severe heart disease only to find out after much testing that I have Roemheld Syndrome. I am 62 yearsw old and this started when I was in my twenties - I would get heart palpitations or arrythmia (feeling like your heart is skipping a beat), especially after eating a big meal.  I would take an antacid for awhile and eventually the indigestion would subside and so would the arrythmia.  It also felt like everything I was eating was just "sitting" at the  top of my abdomen right under my diaghphram and until I belched about a 100 times, the irregular heartbeat would continue.  I haven't noticed the arrythmia now in about four years and about a month ago it returned with a vengeance ESPECIALLY after eating.  Being older now I was really afraid this was the real thing and I had slipped into actually heart disease (I'm a smoker).  But I still noticed that it was the worst after eating.  When I awoke in the morning the arrythmia was barefly noticeable and after taking my blood pressure med (Toprol) it would improve even more.  After doing some reading on the subject of arrythmia I started on a regimen of Potassium, CoQ10, Magnesium and Folic Acid (which seemed to help a little) but I was still worried what was really going on.  After much testing, I was diagnosed with Roemheld Syndrome....."characterized by presure in the epigastric and left hypochondriac region it is believed this leads to elevation of the diaphragm, and secondary displacement of the heart causing stimulation of the vagus nerve and a variety of cardiac symptoms, e.g. arrhythmia, sinus bradycardia.  This is complemented by gastro-coronary reflexes whereby the coronary arteries constrict with cardiovascular symptoms similar to chest-pain on the left side and sometimes in the left shoulder, dyspnea, sweating, upt o angina pectoris-like attacks and tachycardia even though there are no changes related in the EKG detected.  I am being treated now with an anticholinergic to treat the vagus nerve, an alpha blocker, simethicone, beano and Nexium and the Toprol.  It seems to be helping already but too early to really know for sure.  Just wanted to share in case anyone out there has similar symptoms.

Thank you for sharing and this is a good explanation of Roemheld Syndrome. I am glad you finally received the right diagnosis. For members not familiar with this syndrome the sx may include:

(Symptoms are periodic, and occur only during an "episode" usually after eating)

Sinus Bradycardia
Difficulty inhaling
Angina pectoris
Left ventricular discomfort
Fatigue
Anxiety
Uncomfortable breathing
Poor perfusion
Muscle Pain (crampiness)
Burst or sustained Vertigo or dizziness
Sleep Disturbance (particularly when sleeping within a few hours of eating, or laying on the left side)
Extrasystoles
Hot Flashes
Treatment of the primary gastro interlogical distress is the first concern, mitigation of gastric symptoms will also alleviate cardiac distress.

anticholinergics treats the vagus nerve
Alpha blockers may increase gi motility if that is an issue, also 5 mg to 10 mg amitriptyline if motility is an issue that can't be solved by other methods
antigas - simethicone, beano, omnimax reduces epigastric pressure
antacids - nexium,tums, Pepcid AC, rolaids, etc. reduces acid reflux in the case of hiatal hernia.
If you feel this may be an issue for you, please do seek out the advice of your physician.

Take care all,

Kitt

Hello RS sufferers...

when i get my RS attack, I drink Beer in order to burst the air bubble trapped in my stomach, or I jump up and down or take a walk or lie on my right side to relieve the pressure to the heart...

sometimes drinking a lot (Beer, Water, Baking soda water) will also burst the bubble and burping will then slowly releave the pressure...

you can also massage the vegas? nerve...

I find that when i drink a lot it doesn't happen but when i drink a few swallows it can trigger RS...

it's a scary thing when your heart starts to palpitate and won't quit...

so eat lightly...

be well...

Lore

Andres, wondering how you are doing with the treatment indicated. Also, most Alopathic doctors in US don't recognize Roemhelds and far majority of alternatives, barring some in Germany, haven't heard of it - nor of the symptom profile. Do you have any resources and doctors to recommend. Thanks.

I have. I think I've been suffering with this for about 10+ yrs. I began to get cold at night, and couldn't get warm. I started sleeping in a recliner after that. Back in 2002-3? I had all kinds of problems, but when I was eating a "healthy choice" meal one eve and nearly passed out. I went to the ER and told them that my heart was stopping but they thought I was faking or just crazy or having panic attacks. I continued to have all sorts of problems and saw many Drs and had all kinds of tests done. But they never found anything. What I have done for the past 8yrs has pretty well kept this condition under control? I stayed almost symptom free for 8-9yrs. I made sure to get all my vitamins, minerals, greens, etc. I would mix it all together and drink that in the morning. I would take a good probiotic, usu 35billion or so. And if I started having the digestive problems, I would take herbs to kill parasites. I haven't been doing my "regimen" lately and eating too much fiber and have been having problems again. I would up in the ER again last week and of course, they think you are crazy.

This has come the closest to explaining my symptoms which have been very hard to explain to my doctors. Being treated now for GERD with small sliding Hiatal Hernia and Anxiety. I have had a recent clear cardiac cath done. Symptoms started in 2009 and initially had negative stress tests and have been worked up a couple of times for chest pain. I'm 48 yrs old 5'10" and weight has gone from 190 to 170 due to frequently skipping evening meals (weight loss not a bad thing).
Symptoms I've had:
Sinus Bradycardia (my normal rate is 50s to 60s) so not sure if this is relevant
Difficulty inhaling
Angina pectoris
Abdominal Bloating and gas
Fatigue
Anxiety
Uncomfortable breathing
Burst or sustained Vertigo or dizziness
Sleep Disturbance (particularly when sleeping within a few hours of eating, or laying on the left side) Had several episodes of palpitations with extreme hot sensation all over which wakes me up.
Tinnitus
Tightness in throat
Frequent epigastric pressure and tightness/tenderness in left chest(hypochondriac area)
Have noticed that I can tolerate walking on treadmill to get pulse in the 120s, but doing yard work using upper body (like chopping with an axe) will cause my heart to beat very hard (can feel my pulse through my torso) and I get exhausted quickly. Wonder if this is related to pressure on heart causing some type of sympathetic reflex.

Does anyone know of a particular diet to decrease abdominal gas and bloating?
Am already taking Simethicone, Beano, Prilosec, Zantac, and Probiotics regularly. Will use Maalox, Alka Seltzer, or Baking Soda PRN.
Thanks for any feedback.

ref: roemhelds: check to make sure that you don't have a diverticulum on the stomach, as it can inflate with excess air in the belly and cause issues in addition to those which come with Roemehelds.

Based on my experience, it does not appear that western medicine, nor alternative physicians have an understanding of the Roemhelds paradigm and thus, am pursuing resources in Germany. It appears that physicians there have a much greater understanding of Roemheld's. If interested in the results of my research please respond and if you have resources please respond in kind.

I was diagnosed with GERD 10 years ago and I take 20mg omeprazole daily.  Recently, it seems that omeprazole stopped working and I have suffered GERD-like attacks after meals.  I have very simlar symptoms after eating; gas, belching, abdominal cramps, diarhhea, vertigo, shortness of breath, palpitations (fast and pounding), chest pain, trouble inhaling, nausea, and I cannot lie on my left side.  I am visiting my PCP in a couple of days and will mention Roemheld Syndrome.    

I have weird muscle weakness (especially in my legs), diarrhea after many meals, hot flashes at times, cannot lay on my left side in bed, heart palps mostly fast, fatigue, and dizziness/lightheadedness during my episodes. I have been to ER several times thinking I was having heart issues. My event monitor never showed anything, echo, EKG's and stress test normal. Then my MD put me on Celexa and Xanax prn stating the maybe I was anxious or having panic attacks. I stopped taking those a while ago as they did not help. I had my gall bladder removed and my endoscopy and colonoscopy were normal. I am at my wits end with whatever is going on. My husband and doctor probably think I am crazy. Could this be the Roemheld Syndrome that you all are talking about? I am so tired of felling like I am going to die during these episodes! Forgot to mention that I am now on Omeprazole and Levsin.

Anybody actually get a "cure" for Roemheld yet?

I'm 53, 160lbs, 5'11''. Had symptoms like this since my 20's. Panic attacks, etc.

In 2007 had a major AFIB episode and was converted easily in hospital with Diltiazem and they thought it was a lone incident. I now realize that I had eaten a very big meal (with friends who love to cook and tell you eat! eat! and I did) with a few cups of tea and dessert. Never put the 2 together until recently.

Then I had a TIA (small stroke) in 2008 and an MRI revealed 4 previous silent TIA's so they assumed the AFIB was the cause and put me on Warfarin which has been ok until recently. Aug 30 of 2012 I had a minor heart attack (minor in that I had almost no muscle damage, it was barely detectable) and they put me on Digabitran (Pradax or Pradaxa in Canada) and that set off my stomach like crazy.

Within a few weeks I had to get off the Pradax but then the PVC's and AFIB really started kicking in, especially at night. I go to sleep at about 10:30 and usually wake up at about 3:30 in AFIB (which I can luckily usually stop with the ValSalva manouvre) but then it's like that for the rest of the night every 20 minutes to an hour. It drives me crazy.

I'm going for a virtual colonoscopy on Apr 4th and a gastroscopy on Apr 15th but I believe that I (and maybe many of you IMHO) have Helicobactor Pylori infections causing ulcers that cause the inflamation, that causes the gastric pressure that causes our symptoms.

Unfortunately this particular Gastroenterologist refuses to treat me unless he has a confirmed diagnosis of H. Pylori so I will have to survive another month like this and hope the biopsies come back positive.

I will keep you informed but if anyone has had similar issues and found success I'm all ears.

BTW, my best solution for managing the condition so far is: small meals MANY times a day, Pepto Bismol (or any Bi****h Sulfate product) multiple times a day to keep inflammation down and especially rightr before bed time. I'm also eating Manuka Honey, which may sound like a typical "internet hokus pokus cure" but the FDA has actually recognized the antibacterial properties of Manuka honey and considers it a valid treatment option for H. Pylori.

Anyway, that's my $0.02 for now.

Rick, Whitby, Ontario, Canada.

I am so glad I found this forum even though, at this point in time, I had, through my own experience over the last 20 years, decided my "heart issues" were in fact digestive related. Consulted many doctors through the years, not only about cardiac issues but also digestive issues (heartburn, reflux, hiatal hernia) and not one mentioned the possibility of connection between palps, etc. and digestive issues. In 2012 heart symptoms became more frequent and while eating dinner one evening had so many palps I nearly fainted, which scared me. Went to see my cardiologist and he suggested another event monitor for 7 days. Again, at that time, as all prior visits, I said I felt problems were connected in some way to eating. Heart event monitor recorded PAC, PVC, SVT and bradycardia. Most of this immediately after eating.

I had a one and only episode of AFib in 2008 (after eating). Hospitalized and all heart test performed, including cath (which showed clear arteries).

I was feeling really unwell and had some right side and back pain at the time I was wearing the event monitor so my pcp ordered scan of gallbladder, which did show gallstones and sludge. I had gallbladder surgery in April 2012. To my surprise, because I had no idea that a diseased gallbladder could effect heart, about six months after surgery all of the heart irregularities had lessened greatly. I was hoping they were gone. Not so lucky, I still have to be very careful to control gas, constipation, heartburn, reflux or I will still have an "episode". Hence my joy (seems strange to feel "joy") at finding this malady has a name. I do believe it is what I have.

I would like to know if anyone has symptoms so severe they feel faint. And, what would cause a faint, SVT or bradycardia?