Association of Arrhythmia in Patients with Cervical Spondylosis

pattismith

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Since my osteopathic session 3 weeks ago, with spine manipulation, my condition worsened and new symptoms showed up.
One of them is feeling of my heart beat in my chest (like if the heart was jumping in my chest) and even in my throat, at times….
I had a look at recent studies about a possible explanation, and...
Again it's a chinese study that is interested in the link between sympathetic nervous system dysfunction and cervical stenosis…...


Association of Arrhythmia in Patients with Cervical Spondylosis: A Nationwide Population-Based Cohort Study 2018

Shih-Yi Lin 1,2, Wu-Huei Hsu 1,3, Cheng-Chieh Lin 1,4, Cheng-Li Lin 5,6, Chun-Hao Tsai 1,7, Chih-Hsueh Lin 1,4, Der-Cherng Chen 7, Tsung-Chih Lin 8, Chung-Y. Hsu 1 and Chia-Hung Kao 1,9,10,*

1 Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 404, Taiwan

Abstract
Background: Sympathetic activity, including cervical ganglia, is involved in the development of cardiac arrhythmias. Objective: The present study investigated the association between cervical spondylosis and arrhythmia, which has never been reported before.

Methods: Patients newly diagnosed with cervical spondylosis (CS) with an index date between 2000 and 2011 were identified from the National Health Insurance Research Database. We performed a 1:1 case-control matched analysis. Cases were matched to controls according to their estimated propensity scores, based on demographics and existing risk factors. Cox proportional hazard models were applied to assess the association between CS and arrhythmia.

Results: The CS cohort comprised 22,236 patients (males, 42.6%; mean age, 54.4 years) and non-CS cohort comprised 22,236 matched controls.

There were 1441 events of arrhythmia in CS cohort and 537 events of arrhythmia in non-CS cohort, which 252 and 127 events of atrial fibrillation in CS and non-CS cohort, 33 and 12 events of ventricular tachycardia in CS cohort and non-CS cohort, 78 and 35 events of supraventricular tachycardia in CS cohort and non-CS cohort.


The CS cohort had an arrhythmia incidence of 11.1 per 1000 person-years and a higher risk [adjusted hazard ratio (aHR) = 3.10, 95% confidence interval (CI) = 2.80–3.42] of arrhythmia, 2.54-fold aHR of ventricular tachycardia (95% CI = 1.70–3.79), and 2.22-fold aHR of atrial fibrillation (95% CI = 1.79–2.76) compared with non-CS cohort.

Conclusions: Cervical spondylosis is associated with a higher risk of arrhythmia.
 
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pattismith

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Another chinese team with an even more recent study (2019)
@valentinelynx

Effects of decompressive operation on cardiac autonomic regulation in patients with cervical spondylotic myelopathy: analysis of blood pressure, heart rate, and heart rate variability
  • Peng Li
  • Zihan Wei
  • Haoping Zhang
  • Kainan Zhang
  • Junwei Li
Purpose
To investigate the effects of cervical decompression operation on cardiac autonomic regulation and its relationship to recovery of somatic neurological function in cervical spondylotic myelopathy (CSM) patients.
Methods
One hundred and thirty-two consecutive patients were enrolled in this study, in which 73 patients received decompression operation and the remaining 59 were treated non-operatively. The follow-up period was 6 months. Baseline and follow-up evaluation included Japanese Orthopaedic Association (JOA) score, office-based blood pressure (BP) measurement, heart rate (HR), and 24-h heart rate variability (HRV) assessment. Relationship between achieved JOA score (final JOA score–baseline score) and changes of BP, HR, and HRV parameters in both operative and non-operative groups was analyzed.

Results
In operative group, patients’ JOA score and markers of parasympathetic activity in HRV assessment were significantly higher than baseline level 6 months later.
Blood pressure, especially systolic blood pressure (SBP), was significantly downregulated in both hypertension and non-hypertension patients.
Mean heart rate was also significantly decreased. Furthermore, achieved JOA score was significantly negatively correlated with changes of SBP, minimal HR, mean HR, maximum HR, but significantly positively correlated with changes of HRV parameters reflecting parasympathetic activity.
However, changes of JOA score, BP, HR, and HRV parameters in non-operative group were not significant.

Conclusions
Cervical decompression operation could improve both somatic neurological function and cardiac autonomic regulation in CSM patients, and achieved JOA score was significantly positively correlated with improvement in HRV and cardiac parasympathetic activity.
 

Sushi

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In operative group, patients’ JOA score and markers of parasympathetic activity in HRV assessment were significantly higher than baseline level 6 months later.
But higher parasympathetic activity doesn’t always correlate with less incidence of arrhythmia. A great deal of arrhythmias are parasympatheticly triggered. This has been my experience and the experience of many other patients. Parasympatheticly triggered arrhythmias can sometimes be terminated by aerobic activity which increases sympathetic activity.

Or maybe I’m reading this backward?
 

pattismith

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But higher parasympathetic activity doesn’t always correlate with less incidence of arrhythmia. A great deal of arrhythmias are parasympatheticly triggered. This has been my experience and the experience of many other patients. Parasympatheticly triggered arrhythmias can sometimes be terminated by aerobic activity which increases sympathetic activity.

Or maybe I’m reading this backward?
I'm interested in your post, as sympatheticly triggered arrythmia is linked to increased blood pressure, which I don't have, so maybe parasympathetic nervous system is at play for me?

In this 2018 japanese study they suppose that sympathetic hyperactivity associated to cervical spinal spondylosis is the trigger for spondylosis hypertension association:

"Results
A significant Blood Pressure reduction was observed in the HyperTension group 6 months after surgery, but not in the normotensive group (n=29).

The effect was more remarkable in the HyperTension-refractory group.
......
Conclusion
Hypertension coexisting with CervicalSpondylosisMyelopathy can be ameliorated after surgical treatment.
The effect is likely to be mediated by moderation of sympathetic activity, rather than parasympathetic activation. We believe that a combination of adequate decompression of the spinal cord and relief from musculoskeletal stresses effectuate this moderation."
 

sb4

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One of them is feeling of my heart beat in my chest (like if the heart was jumping in my chest) and even in my throat, at times….
I have had this since the start and it is my worst symptoms. Feels like your heart is pounding hard constantly in your chest. Gets worse upon eating, exercise, heat, etc. Very uncomfortable / painful.
 

pattismith

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I have had this since the start and it is my worst symptoms. Feels like your heart is pounding hard constantly in your chest. Gets worse upon eating, exercise, heat, etc. Very uncomfortable / painful.
I agree with you, it is a very unpleasant feeling. I wonder if it relates to some heart beat anomaly, or if it is just a sensitivity issue.
It is not permanent for me, so I'm not sure I will catch it with an ECG.
Did you have any heart investigation?
 

sb4

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I agree with you, it is a very unpleasant feeling. I wonder if it relates to some heart beat anomaly, or if it is just a sensitivity issue.
It is not permanent for me, so I'm not sure I will catch it with an ECG.
Did you have any heart investigation?
Yes, I have had ecg, echo-cardiogram, 24hr heart monitor, tilt table test, and multiple BP readings. All came back normal apart from tilt table which landed me with the diagnosis of POTS. Whenever I bring up this symptom, even to POTS doctors/nurses, it is written off as hyper-vigilance despite my strong protests. Hyper-vigilance is more psych tier BS.

The thing is, I have seen numerous websites list heart pounding as a separate symptom to heart racing in relation to POTS so it appears some recognize it as a problem. I am not sure what is causing it, I think it could be low fill volume, possibly left ventricle (???) overcompensating for poor stroke volume, lack of energy (gets dramatically worse with carbs, lactate PDH???), or maybe messed up autonomic signalling in general, or who knows what.

It is very interesting to me as it is my most disabling symptom and I think it would be plausible that most of my other symptoms would clear up if my cells received proper blood flow.
 

pattismith

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Yes, I have had ecg, echo-cardiogram, 24hr heart monitor, tilt table test, and multiple BP readings. All came back normal apart from tilt table which landed me with the diagnosis of POTS. Whenever I bring up this symptom, even to POTS doctors/nurses, it is written off as hyper-vigilance despite my strong protests. Hyper-vigilance is more psych tier BS.
I understand that this palpitation problem is often blamed on anxiety, which is the easy basket doctors like to put patients. You certainly know better than any doc if this diagnosis is acurate, and I don't believe anxiety to be the culprit for me either.

Here some interesting articles:

"The awareness of heart action can be described as a “pounding” that can be felt in the chest and/or neck. It can be perceived as an irregular, rapid, or forceful heartbeat, which can be intermittent or sustained; episodic palpitations are commonly described as “skipped beats.” Most palpitations are caused by normal sinus rhythm, although depending on the population, can be a result of cardiovascular causes in up to 40% of patients; in many cases, because of their episodic nature, the exact cause remains undefined."

"If the patient does not have any high-risk features and the palpitations are not particularly bothersome, then reassurance can be offered. Otherwise, ambulatory cardiac monitoring should be performed using a patient-activated continuous loop monitor for up to 2 weeks or until a diagnosis is made. This approach is more cost-effective than using a Holter monitor, which is less likely to capture a significant event as a result of its shorter monitoring period."

" Catecholamine excess alone can cause a sensation of palpitations without an arrhythmia even being present.17

Some causes of palpitations include the following: anxiety; severe viral syndrome; alcohol; stimulants (cocaine, methamphetamine); stimulant medications including pseudoephedrine; drinks containing caffeine, theobromine, or theophylline; poor sleep (or an irregular sleep cycle); and several supplements (including Ginkgo biloba, ephedra, ginseng, guarana, horny goat weed, yohimbe, and others). Hormonal changes and excess thyroid hormone can also lead to palpitations."
 

Sushi

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I'm interested in your post, as sympatheticly triggered arrythmia is linked to increased blood pressure, which I don't have, so maybe parasympathetic nervous system is at play for me?
I don’t have high BP either. I tested as parasympathetic dominant in autonomic testing, I have Afib (well controlled) but every episode I had began in the wee morning hours when I was asleep—which points to a parasympathetic trigger.
agree with you, it is a very unpleasant feeling. I wonder if it relates to some heart beat anomaly, or if it is just a sensitivity issue.
It is not permanent for me, so I'm not sure I will catch it with an ECG.
My “thuds” were PACs (premature atrial contractions). There are also premature ventricle contractions which can also feel like thuds. I don’t think it is hyper vigilance as since I got a pacemaker with an algorithm to outpace PACs, I don’t get anymore thudding beats. Yes, it can be hard to capture these on an EKG, so a lot of patients who get weird heart sensations use the KardiaMobile (an FDA approved means of taking an EKG that works with your phone.). 1566062875801.jpeg It is smaller than a credit card so I carry it in my purse and if I get any questionable readings (it automatically does a computer read), I just email the PDF to my electrophysiologist (cardiologist who specializes in heart rhythms). A lot of peace of mind for $99.
 

sb4

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@pattismith That is the trouble with this symptom, heart pounding can mean many things to different people. Most people think racing heart, others think palpitations which is skipped beats. For me it is the forceful pounding of the heart such that I can feel my body vibrate strongly with each beat and is visible from the outside too (which it wouldn't be if I were just hyper vigilant).

For me I think this is a key symptom that sets me apart from most people on this forum. I think it is a case of the same type of cause causing a different effect. I don't have PEM, it appears most PWME don't have forceful pounding heart. However, I do have poor tolerance to carbs, lactic acid build up, post viral onset, and many other issues that are linked.

It's just trying to piece together how it is all linked. Possibly through autonomic / brain-stem dysfunction.
 

pattismith

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@pattismith That is the trouble with this symptom, heart pounding can mean many things to different people. Most people think racing heart, others think palpitations which is skipped beats. For me it is the forceful pounding of the heart such that I can feel my body vibrate strongly with each beat and is visible from the outside too (which it wouldn't be if I were just hyper vigilant).

For me I think this is a key symptom that sets me apart from most people on this forum. I think it is a case of the same type of cause causing a different effect. I don't have PEM, it appears most PWME don't have forceful pounding heart. However, I do have poor tolerance to carbs, lactic acid build up, post viral onset, and many other issues that are linked.

It's just trying to piece together how it is all linked. Possibly through autonomic / brain-stem dysfunction.
Yes, I noticed my heart pounding was visible from the outside like you. I am convinced that this is not something normal nor from anxiety. I stopped coffee and it does not change anything.
I didn't catch any arrhythmia with my EKG, so I did EKG + some vagal stimulation and my heart rate didn't react as it should. The HR increased instead of slowing during stimulation, and I got some strange extrasystoles that I cannot interpret. I didn't find anything on my books that fit with HR increasing under Valsava maneuver, so I am thinking of some side effects from the drugs I am currently taking for my spine inflammation. I have to stop everything and see if it resolves...
 
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One of them is feeling of my heart beat in my chest (like if the heart was jumping in my chest) and even in my throat, at times... [/B]
I have had this since the start and it is my worst symptoms. Feels like your heart is pounding hard constantly in your chest. Gets worse upon eating, exercise, heat, etc. Very uncomfortable / painful.
I had this very exact problem guys, and it's really not anxiety (even though everyone was telling me it was anxiety - idiots). I tried a calcium channel blocker and it went away completely, almost instantly. Not only that, but I felt the circulation in my body coming back and bringing it back to life. I came to the conclusion that it's due to excessive intracellular calcium effecting muscles and blood vessels. Probably the arteries surrounding the heart and lungs (i also had difficulty breathing being upright) become too narrow and the heart finds it difficult to pump blood or something.

@sb4 have you tried Cinnarizine in the end?
 

sb4

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have you tried Cinnarizine in the end?
Thanks for reminding me @GloriaDG I did try it and forgot to update your thread. I noticed I felt maybe a bit better (though hard to tell) however it negatively effected my sleep in a heart based way. When my symptoms were real bad my sleep was terrible and my heart would feel as though it was struggling and I would have things like adrenaline shots waking me up as I was nodding off and other symptoms of my heart felling off.

Anyway over the 2 days I took Cinnarizine I noticed a slide back in that direction. Day 1 I took 15mg x2. Day 2 I took 150mg split over several doses. I wanted to take high dose to see if it would have effect. Again maybe felt a bit better heart wise through the day but the heart based sleep issues at night returned.
 
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Thanks for reminding me @GloriaDG I did try it and forgot to update your thread. I noticed I felt maybe a bit better (though hard to tell) however it negatively effected my sleep in a heart based way. When my symptoms were real bad my sleep was terrible and my heart would feel as though it was struggling and I would have things like adrenaline shots waking me up as I was nodding off and other symptoms of my heart felling off.

Anyway over the 2 days I took Cinnarizine I noticed a slide back in that direction. Day 1 I took 15mg x2. Day 2 I took 150mg split over several doses. I wanted to take high dose to see if it would have effect. Again maybe felt a bit better heart wise through the day but the heart based sleep issues at night returned.
Ah, that's a shame to hear that it affected your sleep. It's really amazing how we all react differently to drugs. To me it really means that we all probably suffer from different things. Anyway, I hope you'll find something that helps you soon.
 

pattismith

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@pattismith Yeah I think my ANS is messed up in regards to parasympathetic things. An example would be, I purchased heart math device to try and modulate my HRV. If I do the breathing they recommend (I think 6 in 6 out) I feel worse and not relaxed at all.
what I found in my EKG may be useful for you.

I stopped all my meds for 38 hours now, and the problem is still there although less severe.
I have extrasystoles (arrhythmia), but they are not easy to catch.
I did a Valsava maneuver under EKG supervision (it's not totally safe to do it without supervision, so I don't avise it), and I had a big surprise.
Your heart rate is supposed to slow down when doing a valsava a few second (about 5 seconds), but mine didn't slow down. Instead my HR increased. So I kept the valsava, and between 5 and 15 seconds, I had extrasystoles showing up (one to three). My sinusal heart rate was restored as soon as I stopped the Valsava.

Valsava maneuver is supposed to activate parasympathetic control on the heart (via increased pressure on the chest vagus nerve), so this activation doesn't seem to work for me, and I don't know why.

My basic heart rate is 83-89/mn, and under valsava 89/93.

I have to figure out what is happening, and if drugs just showed up something latent. I suspect the problem was latent, because my basic heart rate didn't changed before/after starting the drugs, but pure drug toxicity can also be involved, which I would prefer, as I may have more luck to recover from (i hope).

I did pictures of my EKG, but didn't succed to send it on PR, so will try again later.

Just wanted to share that with you, as maybe your heart problem would have better chance to show up under the valsava maneuver. Did your cardio checked your EKG during this test?

1566306385524.png
 
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sb4

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@pattismith Thanks, thats very interesting. What drugs where you on? If I remember right you where taking T. Are you saying you got these new heart problems from the drugs? For some reason I thought you said it came on after traction.

As for Valsalva when I did my second set of POTS tests in London I distinctly remember having to blow into a tube offering resistance whilst tilted up, I also think I was asked to do valsalva although they didn't comment other than saying I had POTS (and that it was caused by deconditioning of which I am certain it is not).

I have just done a very rudementary version of the test, I had 86bpm at rest and 110 ish bpm with valsalva although it is very much an estimate, I just counted beats in the 10 seconds I performed it and multiplied by 6.

Is it common to have a rebound increase in BPM in healthy people straight after finishing the maneuver? Did you experience your HR increasing straight after? Looking at your EKG it appears your HR dropped straight after, unless I am reading it wrong.
 

pattismith

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@sb4
after my session with a osteopath chiropractor for bad neck pain, I deteriorated quickly: my neuropathic pains got worse, so I started Azithromycin + piroxicam + paracetamol, and I did some neck tractions (over the door).
It helped some of my pains, but after some time (maybe 2 or three weeks), palpitations occurred.
azithro can have heart toxicity but most of the time when associated with other cardiotoxic drugs.

Normal EKG during valsava shows decreased sinusal HR during stimulation of the vagus nerve, and increased HR after stopping the maneuver.

My Valsava shows just the opposite: a slight increased HR during the maneuver, and a slightly decreased HR after the maneuver (this post-maneuver part is not shown in the EKG I published above)
The second anomaly in my EKG is the ventricular extrasystole:
Valsava is not supposed to favor ventricular extrasystoles, but it favors ventricular parasystoles. So mine are probably ventricular parasystoles, but this arrhythmia doesn't explain why the parasympathetic activation of my heart doesn't slow my HR...and if the two are related or not....
 

pattismith

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@sb4
Did you check your thyroid levels?

I finally got the answer to my chest palpitations : hyperthyroidism!
Hyperthyroidism is known to produce hypersympathetic tone + hypoparasympathetic tone, and arrhythmia.
I found one study stating that 100% of hyperthyroid patients' EKG under Valsava are borderline or abnormal, so I have hope that all will resolve when my thyroid problem will be fixed!