The cold drink heart
A 56-year-old physician noted the onset of fast, irregular palpitations after ingestion of a few sips of a frozen margarita. He recognized the likely onset of atrial fibrillation, confirmed on an electrocardiogram, and self-treated it with aspirin and a beta-blocker. It resolved overnight. A subsequent medical workup, including thyroid function testing, an echocardiogram, and a treadmill stress test, were all normal.
In the ensuing years, there have been three subsequent similar episodes, all triggered by the ingestion of very cold substances. One happened immediately after several bites of an ice-cream cone, while biking on a hot summer day. Another occurred while drinking iced tea and eating sorbet. The last one happened during dessert (coffee ice cream over a meringue, with Kahlua added).
In view of this personal experience, the physician has alerted patients prone to paroxysmal atrial fibrillation to avoid ingestion of very cold substances. One, a middle-aged veteran jogger, had reported similar symptoms after a large glass of cold water following completion of a 10-km road race. An electrocardiogram documented atrial fibrillation, which resolved spontaneously after several hours.
The heart and the esophagus are in close proximity. Ingestion of very cold drinks or desserts can trigger paroxysmal atrial fibrillation and probably other arrhythmias. Patients should be notified as to the importance of avoiding such triggers.
When our index patient mentioned to his wife the various things that had stimulated his paroxysmal atrial fibrillation, her response was something like, “If you had half a brain you would avoid doing those things.”
—John Davis Cantwell, MD
Piedmont Heart Institute, Atlanta, Georgia
john.cantwell@piedmontorg