Gastroesophageal Reflux Disease (GERD) is a chronic condition involving the frequent backflow of stomach acid into the esophagus. Palpitations are the sensation of the heart beating too fast, too hard, or skipping a beat. Although the heart and digestive system are separate, GERD symptoms and heart palpitations often occur together. Understanding this underlying connection and managing the reflux is the primary step in controlling these heart sensations.
The Physiological Link Between Reflux and Heart Sensations
The proximity of the esophagus to the heart is a major factor in why GERD symptoms can mimic cardiac issues. The esophagus runs directly behind the heart, and acid-induced irritation in this area can cause referred pain and sensations in the chest. These sensations may feel like the heart is fluttering or pounding, even when the heart’s electrical rhythm is normal.
A more direct link involves the vagus nerve, which acts as a communication pathway between the brain, the gut, and the heart, playing a major role in regulating both digestion and heart rate. When stomach acid refluxes, the resulting irritation and inflammation in the esophageal lining can stimulate the vagus nerve. This irritation can then trigger a reflex that results in an irregular or accelerated heart rhythm, leading to the sensation of palpitations.
Another potential cause of heart sensations is esophageal spasms, which are painful, uncoordinated contractions of the muscles in the esophagus. These spasms can be triggered by GERD and produce intense, squeezing chest pain often mistaken for a heart attack. Furthermore, the pressure from trapped gas or bloating associated with GERD can push against the diaphragm, which can influence the heart, causing temporary rate changes.
Immediate Lifestyle and Dietary Relief Strategies
Controlling GERD-related palpitations often begins with making adjustments to daily habits and diet. Positional changes during and after meals can significantly reduce the likelihood of acid reflux occurring.
Positional Changes
It is important to remain upright for at least two to three hours after eating, as lying down allows stomach contents to more easily flow back into the esophagus. Elevating the head of the bed by six to nine inches, using blocks or a wedge pillow, uses gravity to keep stomach acid in place overnight. Stacking pillows is less effective, as it only bends the neck and not the torso, which is necessary to prevent reflux. Wearing loose-fitting clothing and avoiding tight belts or waistbands helps reduce pressure on the abdomen and the lower esophageal sphincter.
Diet
Dietary changes are also important steps to prevent irritation. Eating smaller, more frequent meals throughout the day, rather than three large ones, prevents the stomach from becoming overly full. A full stomach increases the pressure that can force acid upward. Common triggers should be avoided as they relax the lower esophageal sphincter or increase acid production:
- High-fat foods
- Spicy foods
- Caffeine
- Alcohol
- Chocolate
- Mint
Managing stress through deep-breathing exercises, yoga, or meditation is beneficial, as anxiety can independently trigger or worsen both GERD symptoms and palpitations.
Medical Approaches to Controlling Underlying GERD
When lifestyle adjustments are insufficient, medications can provide relief by targeting the production or neutralization of stomach acid.
Antacids
For immediate, occasional relief, over-the-counter antacids containing calcium carbonate or magnesium hydroxide can quickly neutralize acid already in the stomach. However, antacids only offer temporary symptom relief and are not a solution for chronic GERD.
H2 Blockers
A longer-acting option for more frequent symptoms is the use of H2 blockers, such as famotidine. These medications work by blocking histamine receptors on the stomach’s parietal cells, which reduces the amount of acid the stomach produces. H2 blockers begin working within a few hours and can provide acid suppression for several hours, making them effective for mild to moderate, intermittent heartburn.
Proton Pump Inhibitors (PPIs)
For consistent, chronic GERD, a physician may recommend a long-term treatment with Proton Pump Inhibitors (PPIs), such as omeprazole or esomeprazole. PPIs work by irreversibly blocking the proton pumps, which are the final step in acid production within the stomach’s lining. These are the most potent acid-reducing medications and require consistent daily use, ideally 30 to 60 minutes before the first meal, to achieve full efficacy over several weeks. Controlling the underlying acid reflux is the most reliable way to eliminate the secondary symptom of palpitations.
When to Seek Emergency Medical Attention
While the connection between GERD and heart sensations is real, chest pain and palpitations should never be assumed to be solely digestive in origin. Seek immediate medical attention if palpitations are accompanied by warning signs that indicate a serious cardiac event requiring urgent evaluation. Call emergency services if the palpitations include sudden, severe chest pain that does not resolve, especially if the pain radiates to the jaw, neck, arm, or back. Other warning signs include severe shortness of breath, sudden dizziness or lightheadedness, or breaking out in a cold sweat. Do not attempt to self-diagnose; a medical professional must rule out a cardiac cause for the symptoms.