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Reflux and HCM


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Lisa Salberg Find out more about Lisa Salberg
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  • Reflux and HCM

    I have noticed that a very large percentage of those with HCM have reflux - this made me wonder about a connection. Well it seems as though there is a very obvious answer. Both beta blockers and calcium channel blockers can actual cause or aggravate reflux - as most people with HCM are on one or both of these meds... it is no wonder that many have reflux.
    This is a nice outline that I found on line that discusses reflux AKA GERD.

    1) Most people experience heartburn at some time in their lives.
    a) Heartburn is most often caused by gastroesophageal reflux, or leakage of stomach
    acid backwards into the esophagus (“food tube” from mouth to stomach).
    b) A small amount of gastroesophageal reflux is normal, but repeated reflux of large
    amounts of acid is not. This is gastroesophageal reflux disease (GERD).
    2) About 7% of Americans have daily heartburn. Many of these have GERD.
    3) Symptoms of GERD (you don’t have to have all of them):
    a) Heartburn
    b) Acid taste in the mouth
    c) Abdominal bloating
    d) Difficulty swallowing
    e) Chronic cough
    f) Wheezing
    g) Hoarseness
    h) Chest pain
    4) The lower esophageal sphincter (LES) is a ring of muscle around the bottom of the
    esophagus, just before it enters the stomach. The LES loosens up to allow food to
    pass into the stomach, and tightens to prevent acid from refluxing back up. In GERD,
    the LES often doesn’t stay closed when it should.
    5) Some things make GERD worse:
    a) Alcohol
    b) Caffeine
    c) Cigarettes
    d) Obesity
    e) Eating before bedtime
    f) Chocolate
    g) Peppermint
    h) Acidic foods, such as tomato-based foods, citrus, etc.
    i) Hiatus (or hiatal) hernia (the junction between the esophagus and stomach slides
    up out of the abdomen and into the lower chest).
    j) Certain medications
    i) Calcium channel blockers
    ii) Beta-blockers
    iii) Nitroglycerin
    iv) Theophylline
    v) Progesterone
    6) Complications
    a) Esophagitis – inflammation of the esophagitis. Occurs in about ½ of people with
    b) Barrett’s esophagus – the esophagus gets so irritated for so long that it changes its
    lining in an attempt to protect itself. In a small percentage of patients, this can
    become serious (chronic irritation, cancer).
    c) Asthma
    d) Pneumonia
    e) Vocal cord irritation and hoarseness or voice changes
    7) Treatment
    a) Lifestyle changes
    i) Lose weight if overweight
    ii) Avoid alcohol, caffeine, chocolate, tomatoes, citrus products, especially
    within a few hours before bedtime.
    iii) Avoid large meals
    iv) Elevate head of bed. Use bricks under bedposts; do not use extra pillows.
    v) Do not lay down or go to bed within 3 hours after a meal.
    b) Medications
    i) Antacids – Maalox, Mylanta, Tums, Gaviscon, etc. These are often enough
    for milder symptoms, and can be added to other medications below.
    ii) H2 blockers – Tagamet, Zantac, Pepcid, Axid. They decrease the amount of
    acid made by the stomach.
    iii) Proton pump inhibitors – Prilosec, Nexium, Prevacid, Aciphex, Protonix.
    The most powerful medicines for decreasing stomach acid.
    (1) People on these medicines for more than a few months may have difficulty
    coming off them because of a “rebound” phenomenon. However, some
    people with severe GERD need to stay on them.
    (2) Vitamin B12 absorption may decrease with prolonged treatment with
    these medicines. This is usually not a problem.
    iv) Reglan. Tightens up the LES, and allows stomach to empty sooner. May be
    used as an adjunct to other medicines.
    c) Surgery. Reserved for the most severe cases.
    Knowledge is power ... Stay informed!
    YOU can make a difference - all you have to do is try!

    Dx age 12 current age 46 and counting!
    lost: 5 family members to HCM (SCD, Stroke, CHF)
    Others diagnosed living with HCM (or gene +) include - daughter, niece, nephew, cousin, sister and many many friends!
    Therapy - ICD (implanted 97, 01, 04 and 11, medication
    Currently not obstructed
    Complications - unnecessary pacemaker and stroke (unrelated to each other)

  • #2
    Thanks Lisa.

    This helps me understand my symptoms better. While I don't have all those symptoms, I do have enough that it makes me wonder if the heart meds play a role.

    God Squad co-moderator
    Nothing is as gentle as strength and nothing is as strong as gentleness


    • #3

      I hadn't realized that there's a direct connection between beta and calcium channel blockers and acid reflux... thanks for the info.

      It makes sense that a large percentage of HCM'ers also have GI problems, and i think it's quite simple really. The heart works overtime during the digestive process, and if our hearts don't pump as effectively as a normal heart it stands to reason that our digestive tracts would be impaired to some degree. We've all experienced that increase in HCM symptoms after a large meal, right?

      Proper digestion relies quite a bit on gravity and movement as well, and most symptomatic HCM'ers simply can't be as physically active as the average Joe. When symptoms are really bad there are days when we can spend more time horizontal than we do upright. That's not good for digestion... acid backs up, etc. There's also the weight issue to consider. Aside from all the usual factors, HCM'ers tend to have a harder time managing weight because of meds, restricted activity, and metabolism.

      Frankly, i'm surprised all of us don't have acid refux.

      Interesting topic!

      "Some days you're the dog... some days you're the hydrant."


      • #4
        I would love to blaim my heartburn on B-Blockers but I can not. I began getting heartburn with my first pregnancy and it never went away. (That was 8 yrs or so before beginning Atenolol.) It did however worsen with the addition of the Atenolol.
        I had tried different prescription meds. Nothing helped except Tums, which I relied on daily. Then 9 months ago or so, my Dr gave me Nexium, I haven't taken a Tums(or any other antacid) since. Hmm, I sound like a commercial.
        I am cautious though because I was on Propulcid/Prepulcid when it was discontinued due to serious heart disturbances, so now every medication makes me nervous.

        Anyway, super topic of discussion.
        Thanks yet again Lisa.

        It's not what you gather, but what you scatter that tells what kind of life you have lived.

        Dx in Feb/99. Obstructed. No ICD, no surgeries, no family history. 2 sons ages 14 and 6.


        • #5
          Let me explain further - About 2 years ago I was really sick, chest infection, throat, ears, sinus I was on my back and felt horrible. I thought I had pneumonia again but no - I was in the ER for difficulty breathing it was really bad.

          I went to a new doc, pulmonary guy - he gave me nexium without much explanation. I took it for a month and stopped. I returned for a recheck and he said you may want to go back on the nexium - but did not say why. I headed off to an ENT - he took one look at me and said WOW you need Nexium for about a year! I had never had any typical symptoms of reflux, so I was a hard sell - then I thought about little things like the feeling I was going to 'be sick' in my sleep - leaning over to tie my shoes and feeling like I was going to vomit. I had no pain at all.

          I also reevaluated my diet and changed many things (however I can not give up my tea or chocolate - I have my limits )

          Then last week I spoke to someone who also has HCM and reflux. He was telling me about his gastro guy and that his chest pain was directly connected to his reflux and after a lowering of meds and change of diet/habits the reflux was improved as were his symptoms of chest pain.

          This call - and a conversation with a good friend who's child has severe reflux lead me to do a little digging - and WALLA a simple connection was found.

          I will be speaking to some of our advisor's shortly about this issue and see if we can create a better guide to understanding HCM and Reflux!

          Peace to all!
          Knowledge is power ... Stay informed!
          YOU can make a difference - all you have to do is try!

          Dx age 12 current age 46 and counting!
          lost: 5 family members to HCM (SCD, Stroke, CHF)
          Others diagnosed living with HCM (or gene +) include - daughter, niece, nephew, cousin, sister and many many friends!
          Therapy - ICD (implanted 97, 01, 04 and 11, medication
          Currently not obstructed
          Complications - unnecessary pacemaker and stroke (unrelated to each other)


          • #6
            My husband also has trouble with acid. He took Tums for years, even before diagnosis, then he finally moved on to Ranitidine. That only worked for a while and now he's on Aciphex. It seems to do the trick for him. He not only had acid heartburn symptoms, but before he started the Aciphex he had some severe abdominal cramping. We thought he might even be developing an ulcer. It's all better now.


            Husband has HCM.
            3 kids - ages 23, 21, & 19. All presently clear of HCM.


            • #7
              I do too Reenie and Lisa

              I will wake up in middle of the night with the nausea and i was given prilosec years ago when it first came out and i didn't like the salty taste it gave me and quit it i was told i had nodular Gastritis i had an upper GI and it showed thosands of nodules in my esophacus and i do have problems swallowing on a daily bases, so you can include me in on the reflux also

              Diagnosed 2003
              Myectomy 2-23-2004
              Husband: Ken
              Son: John diagnosed 2004
              Daughter: Janet (free of HCM)

              Grandchildren: Drew 15,Aaron 13,Karen 9,Connor 9


              • #8
                Well, I’ve only had a minor problem with this, and so have taken a different approach.

                On a few occasions (I would say rarely, but it’s a bit more common then that) I will get some acid back up to the back of my mouth – ugh. When that happens I usually take something sweet to get rid of the taste. Believe it or not, I have also found that eating something (a small snack) will also help.

                I also found that bending over is a sort of trigger – anything involving the squeezing of my stomach (I picture myself as a tube of toothpaste.) Anyhow, I’ve taken care of this problem by only having shoes where I do not have to tie any laces.

                I take so much medicine now, I am extremely careful about taking anything else that would add to the mix. Consequently, I am willing to experience some occasional discomfort to avoid screwing up the current mix of medications. For example, I take a full aspirin a day medicinally, and the doctor advised against anything else, with the exception of acetaminophen (Tylenol). I have some on hand at home, but I can’t remember the last time I took any. (I now have a pain patch, so I don’t think it would do any good anymore in any case.)

                I do on occasion have large meals (I live in the Las Vegas vicinity where ‘all you can eat’ buffets abound) but I stop before I reach the trigger point for an HCM reaction. (This has become a fine art with me) and stopping when I do has also limited the GURD reaction.

                I hope this means something to somebody.


                • #9
                  Interesting topic! Include me in the list of GERD reflux candidates please? Could do a commercial for Nexium as well. Seems HCM can also contribute to reflux - at least the beta blockers about cured my recurring headaches. Still wondering if i want them back or not
                  \"Hope is disappointment postponed\"

                  Dx in 2004, first symptoms 20 years ago? Obstructed, A-fib, family history!

                  Combined Morrow and (left atrial) Maze procedures & PVI at St. Antonius Hospital, Netherlands, March 28, 2013.

                  Meds (past) propranolol, metoprolol, disopyramide, sotalol, amiodaron, aspirin, dabigatran, acenocoumarol.

                  Meds (current) sotalol, dabigatran, furosemide.


                  • #10

                    Now you've all got me wondering if i might have some reflux issues myself. After my last visit with my PCP, the nurse came back into the exam room with a handful of Prevacid samples and said that the doctor gives them to many of his cardiac patients. I've not taken any to date as i've never thought i had a problem in this area and i'm somewhat of a minimalist when it comes to pills. If i don't absolutely need it, i don't take it. But now i'm looking at this box of free samples and wondering if i should go ahead and try it.

                    Are there any negative effects to taking Prevacid if it is not needed?


                    "Some days you're the dog... some days you're the hydrant."


                    • #11
                      I get heartburn at times...started about 2 months ago...but mine is due to a hiatal hernia caused from constipation...thank goodness for the advice of one of the school nurses I work with. She said to take Metamucil with an ingredient called "psyllium" for the constipation (doc says most likely from the verapamil)....something is finally helping me!!!
                      \"It is not length of life, but depth of life.\"

                      Ralph Waldo Emerson


                      • #12
                        You take Prevacid long enough and you will turn into an old man.

                        I do not have the same problem although I am on 100 mg of Atenolol. In fact, I’m often near the other end of the spectrum. My wife is with you though. She is taking Metamucil daily and often has to also resort to dried fruit and/or prunes. Then, if all else fails, she turns to prune juice – which always seems to get the ball rolling - more sooner then later.
                        Sometimes I wish we could combine our differences and come out even in the end.

                        Sorry about the pun – I just couldn’t pass it up.


                        • #13
                          This is very interesting.

                          I have always had symptoms of GERD. In my tracking down information about atrial fibrillation I found a web site with information discussing Vagally Mediated AFib and for a while suspected that this explained everything. Vagal AFib is not at present formally recognized in the medical community, but clearly plenty of patients find a connection.

                          - Now before Burt steps in here with a funny story about the “Lost Vagus Nerve” let me finish -

                          The Vagus Nerve, apparently the longest nerve in the body, runs from the brain to the stomach and on its way to the stomach is involved with controlling heart rate. When this nerve is over stimulated it has been shown to cause atrial fibrillation. When people speak of “triggers” such as alcohol, chocolate, extremely cold liquids as starting an AFib episode, it is thought that perhaps the vagus nerve has become over stimulated.

                          An EMT told me, while in the back of his ambulance 10 years ago, to try to strain as though on the toilet with a case of constipation. This “vagal maneuver” has been known to stop an AFib episode. It did not in that case, but was successful in scattered episodes that followed.

                          I started wondering about the connection between heart problems and any digestive tract problems when I started seeing chatter here about diverticulitis. I never chimed in on that topic, but was actually hospitalized with a severe bout probably 15 years ago.

                          I think it makes a certain amount of sense that the systems are all tied together somehow.
                          • 1995: Brigham & Women’s Hospital - diagnosed with Atrial Fibrillation
                          • 2004: Falkner Hospital – diagnosed with Congestive Heart Failure
                          • 2004: Tufts NEMC– diagnosed with “End Stage” Hypertrophic Cardiomyopathy
                          • 2005: Genetic Test – Laboratory for Molecular Medicine. HCM confirmed – missense mutation detected in TNNT2 gene
                          • 2009: Brigham & Women’s - Third cardioversion begin Amiodarone for AFib
                          • 2011: Brigham & Women’s - Medtronic ICD implant


                          • #14
                            Originally posted by Boz
                            Now before Burt steps in here with a funny story about the “Lost Vagus Nerve” let me finish...
                            Boz... you know our friend Burton all too well.

                            Okay Burt, here's your chance, buddy... step in here and give it your best!

                            "Some days you're the dog... some days you're the hydrant."


                            • #15
                              Boz, the method you mention has worked for me on many occasions, but I don't have HCM. It's called Val Salva I think. Ask your doctor before trying this, though.


                              Husband has HCM.
                              3 kids - ages 23, 21, & 19. All presently clear of HCM.


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