Can gastroparesis trigger PVCS or PACS?

Question

Hello Doctor,

I have gastroparesis and experience gastroesophageal reflux, but my biggest issue is what feels like premature ventricular contractions (PVCs) or premature atrial contractions (PACs) occurring behind the suprasternal notch, along with a sensation of pressure.

I have undergone a stress echocardiogram and holter monitoring, and the cardiologist has confirmed that it is not cardiac-related. Despite this reassurance, I have been experiencing these symptoms for the past eight months, and it has led to a severe deterioration in my mental health. I am currently an inpatient at a mental health facility.

This is not just anxiety. You can administer high doses of antianxiety medications, including Benzodiazepines (anxiolytics), and it does not stop the sensations. The symptoms worsen after eating. I am literally at my wits’ end and feel completely overwhelmed.

I am reaching out for help right now. I desperately need guidance and effective treatment options.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Based on your complaints, I agree that assessing cardiac history is important. If there are no cardiac issues, that is indeed reassuring.

Regarding your gastrointestinal symptoms, I have reviewed your gastric emptying study. There is evidence of delayed gastric emptying, which is regulated by the autonomic nervous system, and can be influenced by subconscious anxiety, rather than clinical anxiety. Since you are already on medications, this aspect may be contributing to your symptoms.

You mentioned having a scope performed, which I assume refers to an upper gastrointestinal (GI) endoscopy. If the findings were normal, that is also reassuring.

I suggest the following:

Single daily dose of Pantoprazole 20 mg (proton pump inhibitor) once daily.

Gaviscon or any good antacid syrup (antacid) after meals and as needed during symptom episodes.

Probiotics (dietary supplement) into your routine can improve gut microbiota and the overall health of the gastrointestinal tract.

For the retrosternal pressure, since you have already undergone an endoscopy and a gastric emptying study, I hope esophageal manometry has also been considered. If it has not yet been performed, it should be considered, as esophageal motility disorders can present with symptoms similar to what you are experiencing.

I hope this helps.

Thank you.