Can GERD Cause Palpitations?
Yes, GERD can cause palpitations through multiple mechanisms, though this association is uncommon and the palpitations are typically secondary to the underlying gastrointestinal pathology rather than a primary cardiac arrhythmia.
Understanding the GERD-Palpitation Connection
The relationship between GERD and palpitations occurs through several pathophysiological mechanisms:
- Autonomic nervous system dysfunction is documented in GERD patients, with disturbances in parasympathetic activity that may contribute to cardiac rhythm abnormalities 1
- Gastrocardiac syndrome (Roemheld syndrome) represents a rare but established phenomenon where gastrointestinal distension from hiatal hernia or reflux mechanically triggers cardiac arrhythmias, including premature ventricular contractions 2
- Vagal stimulation from esophageal acid exposure can provoke cardiac symptoms through esophageal-cardiac reflexes 1
Clinical Presentation and Diagnosis
When evaluating a patient with both GERD and palpitations, consider the following diagnostic approach:
- Temporal relationship matters: Palpitations that worsen specifically with food intake or postprandially suggest gastrocardiac syndrome rather than primary cardiac disease 2
- Rule out primary cardiac causes first: Obtain a 12-lead ECG to exclude supraventricular tachycardia, which presents with regular paroxysmal palpitations with abrupt onset and termination 3
- Assess for typical GERD symptoms: Heartburn and regurgitation are present in 89% of gastroenterology patients with GERD, though extraesophageal manifestations can occur without GI symptoms in up to 75% of cases 4
Important Clinical Caveats
Do not assume GERD explains palpitations without excluding cardiac causes. The combination of palpitations with other symptoms demands broader investigation 3:
- Palpitations associated with dizziness, near-syncope, or syncope require urgent cardiac evaluation 5
- Heart rates >150 beats per minute are more likely to represent primary cardiac pathology 6
- Ambulatory ECG monitoring is indicated when the etiology cannot be determined from history, physical examination, and resting ECG 5
Management Strategy
The treatment approach should prioritize addressing the underlying GERD:
- Treat GERD aggressively with proton pump inhibitors if reflux symptoms are present, as resolution of the gastrointestinal pathology may eliminate the palpitations 2
- Consider surgical correction in cases of documented hiatal hernia with refractory symptoms, as surgical repair has resolved arrhythmias in documented gastrocardiac syndrome 2
- Avoid treating palpitations in isolation with antiarrhythmic medications or beta-blockers before establishing the underlying diagnosis 3
When GERD is Unlikely to Be the Cause
Be skeptical of GERD as the primary etiology when:
- No temporal relationship exists between eating, reflux symptoms, and palpitations 2
- Sustained tachycardia is present rather than intermittent palpitations 6
- Other systemic symptoms suggest alternative diagnoses such as hyperthyroidism, anemia, or dehydration 6, 5
The evidence supporting GERD as a cause of palpitations comes primarily from case reports and autonomic function studies rather than large controlled trials 2, 1. Therefore, while the association is real, it remains an uncommon presentation that requires careful exclusion of more common cardiac and systemic causes before attributing palpitations solely to GERD.