Vaso-Vagal Discussion

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Re: Heart Palpitations after Eating

From: Heather


I'm 42. I started having palpitations about six months ago, almost invariably in the evening after eating, though I didn't put it together right away.

I usually have wine with dinner and a coffee afterwards, so I said "Aha!", I need to cut out caffeine and alcohol. I did so completely, and the symptoms worsened. I started calling it "Jackrabbit Heart" because of the way it feels. It lasts about 20-30 minutes. It is very very distressing.

After a particularly bad episode recently, I resolved to have some medical investigation. So far it seems to have been normal, but sometimes normal is also an answer.

I wore a Holter for 24 hours and had no symptoms whatsoever. I had resolved to try some of my bad habits while I was on the Holter - 2 cups of coffee in the morning, 2 glasses of wine with dinner, no exercise during the late afternoon and evening, then stair climbing for an hour in the late evening. Nada. Zero. I didn't push the little button once.

After I got the holter off, I went to the local market district, and along with the usual shopping I bought some gummi bears. As usual, I had a herbal tea in the morning that day, and no snacks, chocolate or caffeine, nor any lunch. By 5pm, I was into some work at my desk and I remembered the gummi bears. I snarfed quite a few of them and my arrhythmia began within about twenty minutes of eating them. It was a particularly bad one.

Then, an hour after the palpitations stopped, I experienced the very recognizeable symptoms of hypogycemia. I felt weak, hands and upper body shaky, unsteady, feeling like passing out. This resolved after a glass of orange juice.

I believe that this incident may indicate a cause for my arrhythmia: rapidly rising blood glucose levels coming out of a fasting hypoglycemia, with a resulting reactive hypoglycemia.

Here's the story in english: I don't eat very regularly. By 5pm my blood sugar had been declining since morning tea, and probably didn't really recover from fasting overnight: no breakfast, no lunch! So far so good - I feel fine despite gradually decreasing glucose. Along comes the sugar load of the gummi bears - they're all sugar and easily digested. Blood sugar rises rapidly out of a hypoglycemic state and produces caridiac arrhythmia (PubMed has some great descriptions of this phenomenon), Heart settles down as blood sugar normalizes, but the rapid rate of rise caused by easily digested sugar-loaded gummy bears results in a massive release of insulin. The insulin takes care of the bears, then looks around for a meal and, finding none, causes my blood sugar to crash back to near zero. Adrenals react to this by dumping out adrenalin, thus creating the weak and shaky symptoms of - once again - hypoglycemia.

My main concern is that hypoglycemia-related arrhythmias can be quite serious. I am going to try the Holter again and see if I can recreate the gummi-bear arrhythmia. If it is just premature beats, no problem, but there is some suggestion that more severe rhythm disturbances such as ventricular ectopy, atrial fibrillation and conduction block can be sugar associated - including associations with a rising sugar out of a hypoglycemia.

I may have to start eating breakfast!

This web site is not a substitute for a thorough medical evaluation and diagnosis of your vaso-vagal type symptoms.  Medical treatment and diagnosis is the only acceptable initial response to these serious symptoms since they might present from any number of life threatening and treatable illnesses. It is for you and your physician to rule out more serious illnesses; Please don't use this online forum as an alternative to getting responsible medical attention and being under the care of a physician for the duration of any unknown, suspected or dangerous vaso-vagal syndrome symptoms.
Last changed: June 22, 2007