![]() Further cardiac complications include the formation of gastropericardial fistula, pericardial effusion and arrhythmia. The clinical presentation of hiatus hernia-induced cardiac compression can range from dyspnea to impaired respiratory function, recurrent acute heart failure and ultimately hemodynamic collapse. ECG changes may result in the misdiagnosis of myocardial ischemia. It has thus been implicated with postprandial syncope and angina-like chest pain. ![]() It may also exert a wide spectrum of manifestations mimicking acute cardiovascular events. The intrathoracic migration of a large part of the stomach was confirmed by an upper gastrointestinal barium examination, which was performed after consulting a surgeon, to further assess the extent of the hernia and the potential need for surgical treatment (Figure 3).Īlthough often asymptomatic, hiatus hernia may present with caustic epigastralgia and regurgitation due to concommitant gastroesophageal reflux. The patient subsequently underwent a chest computed tomography (CT) scan a large hiatus hernia was visualized in the posterior mediastinum (Figure 2). Left ventricular contraction was normal and no pericardial effusion was present. The patient was admitted to the Cardiology Department for further investigation.Ī two-dimensional transthoracic echocardiogram, using all standard and modified apical and parasternal views, revealed an amorphous, echolucent mass with the appearance of a left atrial space-occupying lesion (Figure 1, see Additional file 1). Laboratory tests, including cardiac enzymes and cardiac troponin-I, were within normal reference values. The 12-lead electrocardiogram (ECG) demonstrated sinus rhythm with non-specific "scooping" ST-segment depression in leads III, aVF, V4–V6, attributable to her current medication. ![]() Her lungs were clear to percussion and auscultation. A grade 3/6 holosystolic murmur was audible at the apex. On initial examination her blood pressure was 130/80 mmHg. ![]() Her medical history included chronic heart failure and she was therefore treated with digitalis 0,25 mg/day. Physicians should be aware of the clinical and sonographic findings to facilitate the differential diagnosis from similarly presenting cardiac entities.Īn 82-year-old woman presented to the Emergency Department complaining of sudden onset chest pain radiating to the epigastrium at rest, with less than 1 hour of duration. Hiatus hernia can present as acute chest pain, while its echocardiographic manifestation may resemble a left atrial space-occupying structure. The intrathoracic displacement of a large part of the stomach was further confirmed by an upper gastrointestinal barium examination. A subsequent computed tomography scan visualized a hiatus hernia in the posterior mediastinum, impinging on the posterior left atrial wall. A two-dimensional transthoracic echocardiogram was performed and revealed a structure that was considered to represent a left atrial mass. Physical examination and biochemical tests, as well as 12-lead electrocardiogram, were normal. Case PresentationĪn 82-year old woman presented with acute retrosternal pain indicative of cardiac etiology. Despite the high prevalence of hiatus hernia, a relatively small number of echocardiographically manifested cases have been reported.
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