Arrhythmia in pathologies of the gastrointestinal tract

Arrhythmia is a rhythm disorder that can occur asymptomatically and without threatening the life of the patient or promote the development of dangerous conditions by the type of atrial fibrillation and ventricles.There are various reasons for the development of arrhythmia and among them there are a lot of diseases of the gastrointestinal tract (GIT).

According to statistics, 10% of deaths in the US are due to pathologies of the digestive system, which in such cases are the main cause of comorbidity. [1-Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, et al. (2012) Burden of gastrointestinal disease in the United States: 2012 update.Gastroenterology 143: 1179-1187]

Many of these patients have cardiovascular symptoms, apparently related to their primary disorder. To establish the correct diagnosis, the connection between the cardiovascular and gastrointestinal systems is under intensive research.

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Features of the connection between the heart and the digestive tract

In the normal state, the adult has between 60 and 90 beats / min. In children, the heart rate is somewhat different, especially in the first months of life, when the pulse can reach 140 beats / min. Approximately at the age of 18, the work of the heart begins to correspond to the adult norm.

When determining the rhythm disorder on the background of pathologies of the gastrointestinal tract, they speak of functional arrhythmias.

In the pathogenesis of the development of functional arrhythmias is the interaction of all organs and systems of the body through the autonomic nervous system. Its tasks include monitoring the work of all internal organs. Since it consists of two main divisions, which are in antagonistic action, the heart and the gastrointestinal tract have a different influence of nervous regulation.

Manifestations of the effects of the autonomic nervous system in accordance with the departments:

1. Sympathetic nervous system:

1.1 Heart - heart rate increases, heart rate amplitude increases

1.2 Intestine - the peristalsis is suppressed, the quantity of digestive juices decreases, the force of contraction of the anal opening increases.

2. Parasympathetic nervous system (vagus nerve):

2.1 Heart - the heart rate decreases, the amplitude of heart rate decreases

2.2 Intestine - the peristalsis is strengthened, the quantity of digestive juices increases, the force of contraction of the anal opening decreases.

It is important to note that the sympathetic department of the nervous system mainly manifests its activity in the daytime, and the parasympathetic department at night.

Thus it turns out that if a person has a gastrointestinal disease, a sympathetic nervous system is stimulated because of persistent pain or high temperature, which contributes to a reflex increase in the amplitude and an increase in the heart rate. In such cases, a person other than the symptoms of the underlying gastrointestinal disease may experience changes in the work of the heart.

The main forms of arrhythmia that occur in the pathology of the digestive tract

By the term "arrhythmia" is understood a group of diseases associated with a violation of the rhythm of the heart. These disorders can differ in the mechanism of arrhythmia, the frequency and order of heartbeat. As already mentioned, with gastrointestinal diseases most often develop functional arrhythmias, which in most cases take the form:

• Tachycardia
• Extrasystoles
• Atrial fibrillation

People with inflammatory bowel disease (IBD) are 20% more likely to develop heart disease than the general population, which is higher in women and in people younger than 40, according to a study published in March 2014. Clinical Gastroenterology and Hepatology.

Tachycardia is a determination of heart rate above 90 beats per minute (in an adult). In this case, the patient may feel other symptoms of the disorder:

• weakness;
• fatigue;
• dizziness;
• anxiety;
• tinnitus;
• feeling of a heartbeat or "popping heart out of the chest";
• chest pressure;
• change in skin color;
• nausea;
• cold extremities, etc.

Extrasystoles I - represents an extraordinary reduction, which can be single, pair, group. In their formation lies the presence in the myocardium of an ectopic focus of excitation, which sends intermediate impulses that are not consistent with the main rhythm driver - the sinus node. With functional disorders of the rhythm, such an extraordinary shortening can also be formed, which is associated with a periodic overexcitation of the autonomic nervous system and, accordingly, acceleration of the heart rhythm.

Gastroesophageal reflux disease and atrial fibrillation

Atrial fibrillation (AF) is the most common clinically significant arrhythmia in the general population, and gastroesophageal reflux disease (GERD) is the most diagnosed gastrointestinal disorder in outpatient clinics in the United States and elsewhere in the world. When structural heart disease can not be detected, this heart disease is called secondary, and a thorough examination of the patient can help determine other co-morbidities, including GERD.

Small observational studies and case reports suggested that GERD may lead to AF, and it is believed that this ratio is associated with several mechanisms:

• inflammation,
• autoimmune reactions;
• exacerbation of autonomic stimulation.

Local inflammation of the atria, considering the proximity of the location of the left atrium to the esophagus, and systemic inflammation, in particular secondary to esophagitis, can be important mechanisms for the development of AF. Several studies have already noted that high levels of interleukin-6 (IL-6) and C-reactive protein (CRP), inflammatory mediators that can be increased in GERD, correlate with the frequency and prognosis of AF by tissue remodeling.

An autoimmune response may also underlie the physiopathology of FA, since autoantibodies to the myosin heavy chain have been found in some studies. In addition, stimulation of the vagus nerve is the most reliable trigger, since the cholinergic effect slows the conductivity of the atrioventricular node and the depolarization rate of the sinus node. As a result, the heart rate becomes slow, irregular and signs of arrhythmia appear.

Although large randomized trials are needed to establish an accurate link between GERD and AF, there is some evidence that treatment with GERD with proton pump inhibitors may lead to a conversion to sinus rhythm and an improvement in symptoms in AF. Similar drugs patients, with medical advice, could use as a less expensive drug with fewer side effects.

7 ways to keep the heart healthy in the pathology of the digestive tract

1. Adhering to the treatment plan provided by the attending physician, one can remain in a state of remission, which in turn will help protect the heart, according to a study published in the World Journal of Gastroenterology. You should always take the medicine as directed by the doctor, even if the overall sensations are more than good. By skipping the medication, you can cause a second attack of the underlying disease.
2. It is important to control the level of emotional stress . Stress does not cause gastrointestinal disease, but it can worsen symptoms, help exacerbate and strain the work of the heart. It is necessary to find a strategy to relieve stress, which is most suitable: a. meditation;
   b. yoga;
   c. tai chi;
   d. massage;
   e. physical exercises;
   f. relaxation techniques such as deep breathing.
3. It is necessary to practice healthy food for the heart . Fruits, vegetables and other foods high in fiber are good, but some of them can be harmful in certain diseases of the digestive system. Therefore, in a competent dietary composition, a nutritionist can help, which will take into account trigger foods - useful for the intestine and heart. A doctor or a nutritionist can also recommend some vitamins for taking, as patients with gastrointestinal pathologies often can not absorb enough vitamins and nutrients from food during an exacerbation.
4. It is necessary to carry out regular exercises . In addition, that charging helps reduce the degree of emotional stress, it also allows the heart to work more actively, and the digestive system is better to function.
5. You should quit smoking if there is this bad habit . Sometimes information is received that nicotine helps to prevent the occurrence of ulcerative colitis and other gastrointestinal diseases, but the health risks associated with smoking far exceed any possible benefits of smoking.
6. It is worth checking your life force . If determined more than 40 years, you need to check the level of cholesterol and try to keep it in a healthy range. If there is diabetes mellitus, it is important to work to ensure that the blood sugar level remains within the permissible range.
7. Call the doctor at the first sign of heart failure . If you experience symptoms such as fatigue, heavy breathing, swelling of your ankles and legs, you should immediately seek medical help.

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