Heartburn, the burning sensation caused by stomach acid flowing back into the esophagus, is medically known as acid reflux or Gastroesophageal Reflux Disease (GERD). Heart palpitations are the unsettling feeling that the heart is racing, pounding, fluttering, or skipping a beat. While the heart and digestive system are separate, irritation in the esophagus can translate into changes in heart rhythm. This relationship is often indirect but rooted in shared anatomy and nerve communication.
The Physiological Link Between Reflux and Heart Rhythm
The connection between acid reflux and heart rhythm is mediated by the Vagus nerve, a major communication pathway between the brain and several internal organs. This tenth cranial nerve regulates both the rate of digestion and the resting heart rate. Irritation or inflammation in the lower esophagus, caused by stomach acid, can stimulate the Vagus nerve fibers that run nearby.
The esophagus and the heart are anatomical neighbors within the chest cavity. When the Vagus nerve is stimulated by esophageal acid exposure, it can send signals that interfere with the heart’s natural pacemaker, the sinoatrial node. This reflex action can lead to changes in heart rhythm, perceived as palpitations, premature beats, or a temporary rapid heart rate (tachycardia).
This mechanism is sometimes referred to as gastrocardiac syndrome, or Roemheld syndrome, describing how gastrointestinal issues trigger a cardiac response. Physical pressure from a bloated stomach or trapped gas can push the diaphragm upward against the heart. This compression can also stimulate the Vagus nerve and potentially interfere with the heart’s function.
Furthermore, chronic acid reflux can sometimes be associated with the presence of a hiatal hernia, where a portion of the stomach pushes up through the diaphragm. This structural change can put pressure on nearby structures, including the heart’s chambers, potentially leading to irregular heartbeats. Addressing the underlying digestive irritation is often the first step in resolving these linked heart rhythm disturbances.
Strategies for Managing Reflux-Related Palpitations
Managing reflux-related palpitations focuses primarily on controlling digestive symptoms to remove the source of nerve irritation. Dietary adjustments are foundational, starting with avoiding common reflux triggers. Foods and beverages that relax the lower esophageal sphincter, such as caffeine, alcohol, chocolate, mint, and high-fat or spicy meals, should be reduced or eliminated.
Changing eating habits can significantly reduce the severity of reflux episodes. Instead of consuming three large meals, people often find relief by eating smaller, more frequent meals throughout the day. This prevents the stomach from becoming overly full and reduces pressure that can force stomach contents back into the esophagus.
Lifestyle modifications also include gravitational strategies to keep acid in the stomach. It is recommended to remain upright and avoid lying down for at least two to three hours following a meal. Elevating the head of the bed by six to nine inches, using blocks or a wedge pillow, can also help gravity keep stomach acid down, which is particularly beneficial for nighttime palpitations.
Beyond diet and lifestyle, medical management of acid reflux helps alleviate associated palpitations. Over-the-counter antacids offer quick, temporary relief by neutralizing stomach acid. For persistent symptoms, a healthcare provider may recommend prescription medications that reduce acid production.
H2 receptor blockers, such as famotidine, decrease the amount of acid the stomach produces. Proton pump inhibitors (PPIs), such as omeprazole or pantoprazole, are even stronger acid suppressors. Treating the underlying GERD with these medications often resolves the secondary palpitations, and stress management techniques can help regulate the nervous system and prevent anxiety that worsens both reflux and heart flutters.
When Palpitations Signal a Separate Issue
While a digestive cause for heart palpitations is common, it is important to recognize that heart flutters can also be a sign of a primary cardiac condition. Symptoms that accompany palpitations should serve as immediate red flags, even if acid reflux is known to be present. Any sensation of severe chest pain, often described as a squeezing, tightness, or heavy pressure, warrants immediate medical attention.
Additional symptoms that suggest a heart issue include pain that radiates from the chest to the jaw, left arm, or back, which is not typical of simple heartburn. These symptoms are not usually caused by Vagus nerve irritation from reflux.
Symptoms Requiring Immediate Evaluation
If you experience any of the following, seek rapid medical evaluation:
- Shortness of breath
- Unexplained sudden sweating
- Lightheadedness
- Dizziness
- A feeling of near-fainting
A healthcare provider will perform a differential diagnosis to distinguish between reflux-induced palpitations and a true heart problem. This evaluation may include tests like an electrocardiogram (EKG) to check the heart’s electrical activity, or a Holter monitor, which records heart rhythms over a full day or more. These tests help rule out primary heart conditions, such as atrial fibrillation, which is an irregular heart rhythm often observed in people with chronic GERD.