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Left ventricular obstruction caused by a large hiatal hernia.
Kenji Harada1, Ushio Tamura1, Chiyo Ichimiya1
1Department of Cardiovascular Medicine, Tokushima Prefectural Central Hospital, Tokushima, Japan.
Echocardiography (Mount Kisco, N.Y.)
|May 13, 2017
Summary
A large hiatal hernia can cause chest pain and left ventricular obstruction (LVO) by compressing the heart. This case highlights the importance of considering hiatal hernias in cardiac symptom diagnosis.
Area of Science:
- Cardiology
- Gastroenterology
- Radiology
Background:
- Chest pain is a common presenting symptom in emergency departments.
- Electrocardiogram (ECG) findings suggestive of myocardial infarction can occur in non-coronary cardiac conditions.
- Left ventricular obstruction (LVO) is a serious condition that can mimic acute coronary syndrome.
Observation:
- A 76-year-old man presented with acute chest pain and ECG changes.
- Coronary angiography revealed normal coronary arteries.
- Echocardiography and computed tomography (CT) identified a large hiatal hernia compressing the left atrium and left ventricle.
Findings:
- The hiatal hernia caused significant cardiac compression, leading to left ventricular obstruction (LVO).
- The patient's cardiac symptoms were attributed to mechanical compression by the hiatal hernia, not coronary artery disease.
Implications:
- Hiatal hernias should be considered in the differential diagnosis of patients presenting with chest pain and ECG abnormalities, especially when coronary angiography is normal.
- This case underscores the potential for gastrointestinal conditions to manifest with cardiac symptoms due to anatomical proximity and compression.
- Accurate diagnosis through imaging modalities like CT is crucial for managing cardiac symptoms caused by non-cardiac structural abnormalities.
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