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Recurrent acute heart failure caused by sliding hiatus hernia
1Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
Postgraduate Medical Journal
|April 7, 2005
Summary
A sliding hiatus hernia caused recurrent nocturnal pulmonary edema in a 75-year-old woman. This external compression of the left atrium was diagnosed via echocardiography and confirmed with cardiac catheterization.
Area of Science:
- Cardiology
- Gastroenterology
- Radiology
Background:
- A 75-year-old woman experienced recurrent nocturnal acute pulmonary edema.
- Initial investigations including chest radiography and transthoracic echocardiogram showed normal results, leaving the cause uncertain.
Observation:
- A subsequent transthoracic echocardiogram, performed after the patient was recumbent with a full stomach, revealed severe left atrial compression by an external structure.
- Computed tomography of the thorax identified an intrathoracic mass posterior to the left atrium, consistent with a sliding hiatus hernia.
Findings:
- The intrathoracic mass caused external compression of the left atrium.
- Cardiac catheterization demonstrated a significant increase in pulmonary capillary wedge pressure when the patient was in a recumbent position compared to an upright position.
Implications:
- This case highlights a rare cause of recurrent nocturnal pulmonary edema.
- It emphasizes the importance of considering extrinsic cardiac compression, such as from a sliding hiatus hernia, in cases of unexplained heart failure symptoms.
- Diagnostic imaging and positional changes during cardiac catheterization are crucial for identifying such conditions.
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