Hiatal Hernia Squeezing the Heart to Flutter

Patel, Arpan; Shah, Rushikesh; Aggarwal, Aakash; Nandavaram, Sravanthi

doi:10.14309/00000434-201310001-00734

Cited by 3 publications

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“…The severity of symptoms from these mass effects may also vary depending on whether the patient is lying or standing and inhaling or exhaling and whether the herniated stomach is empty or full [10,11]. Some problems related to cardiac arrhythmia have also been reported, such as atrial fibrillation and flutter [12,13], heart failure due to decreased left ventricular ejection fractions [4], and acute coronary syndrome-like symptoms, and most have been successfully treated by surgical repair of the HH. Milito et al reported the efficacy of using cardiovascular magnetic resonance imaging for assessing symptomatic patients due to large HHs, and stated that laparoscopic repair can restore the cardiac physiological status [14].…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Impairments Caused by a Large Hiatal Hernia with Organoaxial Gastric Volvulus Showing Upside-Down Stomach: A Case Report

Umemura¹,

Sakai²,

Fujiwara³

et al. 2019

Am J Case Rep

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Patient: Female, 74Final Diagnosis: Hiatal hernia with gastric volvulusSymptoms: DyspenaMedication: —Clinical Procedure: —Specialty: SurgeryObjective:Rare co-existance of disease or pathologyBackground:Upside-down stomach (UDS) is the rarest type of hiatal hernia (HH), with organoaxial gastric volvulus. A large HH sometimes causes cardiopulmonary impairments owing to multiple factors.Case Report:We herein report a case of a large HH with UDS that had induced weight loss and severe cardiopulmonary dysfunction in a 74-year-old female patient who presented with shortness of breath, chest pain, severe anorexia, and weight loss of 5 kg over the 3 previous months. Chest X-ray and CT examination revealed that her heart was retracted on the right side, and the hernia contents had induced physical compression of the left lung on the cranial side. Spirometry revealed that the patient’s vital capacity (VC), percentage VC, and percentage forced expiratory volume (% FEV) at 1 s were 1.32 L, 60.2%, and 67.5%, respectively. A barium swallow test confirmed a diagnosis of HH with UDS. On the basis of these findings, we performed a laparoscopic Nissen procedure, which resulted in the patient’s dramatic recovery. Postoperative examinations showed that the stomach and heart were once again normally located, and the left lung had re-inflated. Postoperative spirometry dramatically improved.Conclusions:A large HH causes cardiac and pulmonary compression due to mass effects and leads to cardiopulmonary dysfunction. For cases that have both a complicated HH and cardiopulmonary dysfunction owing to the mass effects of hernia contents, laparoscopic HH repair can be a good alternative procedure.

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Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Impairments Caused by a Large Hiatal Hernia with Organoaxial Gastric Volvulus Showing Upside-Down Stomach: A Case Report

Umemura¹,

Sakai²,

Fujiwara³

et al. 2019

Am J Case Rep

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“…4 Moreover, patients with more frequent gastroesophageal reflux symptoms and/or esophagitis seem to have an increased risk of AF. 5 Similarly, there have been case reports of atrial flutter, 6 junctional bradycardias, 7 anterior T-wave inversion, 8 and ST elevation that have resolved post hernia repair or even after initiation of anti-reflux therapy. 9 , 10 …”

Section: Discussionmentioning

confidence: 99%

Posterior cardiac compression from a large hiatal hernia—A novel cause of ventricular tachycardia

Gnanenthiran

Naoum

Kilborn

et al. 2018

HeartRhythm Case Reports

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“…One current hypothesis suggests that it is the increase in the direct or indirect pressure on the global surface of the heart by the hernia which causes these electrical changes seen on EKG [6]. Another suggests that it is actually due to the compression on the heart by the thoracic stomach causing anatomic conduction block or disruption in the vagal nerve [7]. Intense vagal stimulation has been described before to causing syncope and bradycardia in "swallow syncope syndrome."…”

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confidence: 99%

A Large Intrathoracic Hiatal Hernia as a Cause of Complete Heart Block

Abbood

Salihi

Parellada

et al. 2021

Case Reports in Cardiology

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Hiatal hernia is a not uncommon anatomic disorder resulting in portions of the bowel occupying space in the thoracic cavity. There are a number of antecedent risk factors including obesity but not hiatal hernias resulting in symptoms. When symptoms do occur, they can include chest pain, nausea, abdominal pain, and gastroesophageal reflux. Cardiac arrhythmias have also been reported as associated conditions resulting from a hiatal hernia. To date, however, a complete heart block secondary to a hiatal hernia has not been reported. An 88-year-old female with a history of GERD (gastroesophageal reflux disease) was found to have a large hiatal hernia at endoscopy after she presented to the emergency department with nausea and abdominal pain. Prior to her scheduled surgical repair, she developed symptomatic third degree heart block which resolved with nasogastric tube deflation of the gastric contents. After surgical repair of the hiatal hernia, she developed episodes of atrial fibrillation with rapid ventricular response and was started on diltiazem. She eventually converted back to normal sinus rhythm and remained dysrhythmia free. In addition to other known arrhythmias associated with hiatal hernia, a complete heart block can also be seen. Acute management requires deflation of the chest occupying hernia. This appears to be the one of the first reported cases of complete heart block caused by hiatal hernia.

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Hiatal Hernia Squeezing the Heart to Flutter

Cited by 3 publications

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Cardiopulmonary Impairments Caused by a Large Hiatal Hernia with Organoaxial Gastric Volvulus Showing Upside-Down Stomach: A Case Report

Cardiopulmonary Impairments Caused by a Large Hiatal Hernia with Organoaxial Gastric Volvulus Showing Upside-Down Stomach: A Case Report

Posterior cardiac compression from a large hiatal hernia—A novel cause of ventricular tachycardia

A Large Intrathoracic Hiatal Hernia as a Cause of Complete Heart Block

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