A case report of a giant hiatal hernia mimicking an ST-elevation myocardial infarction

The cardiovascular effects of large hiatal hernias: a narrative review of cases and studies

Hiatal hernia (HH) is a common disease in the general population. It is often asymptomatic, but if it does present clinical manifestations, these are usually gastrointestinal. Gastroesophageal reflux is the main symptom that accompanies it. Depending on the severity of the hernia, it is classified into several subtypes from I-IV. Especially, IV type (giant HH) can lead to various cardiopulmonary symptoms with several degrees of severity. It is necessary to keep this possibility in mind among the various differential diagnoses that may occur in this clinical setting. The current paper aims to review the literature on classic and novel information on the HH - cardiovascular system relationship. Epidemiological data, physiological aspects of the heart compressed by HH, cardiovascular symptoms, electrocardiographic changes, echocardiographic alterations and clinical implications are discussed.

Pseudo-hyperacute T Waves in a Giant Hiatal Hernia

An 89-year-old woman with a giant hiatal hernia complained of persistent chest pain. An electrocardiogram (ECG) showed hyperacute T waves, suggesting the early phase of ST-elevation myocardial infarction. After endoscopic drainage for hiatal hernia, the chest pain disappeared, and the ECG abnormalities resolved. The present case illustrates that compression of the heart by a giant hiatal hernia can induce T wave elevation mimicking acute coronary syndrome.

[A rare cause of type 2 non-ST-elevation myocardial infarction: Cardiac compression and left ventricular obstruction by a giant hiatal hernia]

We report the case of a 89 year-old woman admitted to the emergency department for epigastric pain, nausea, vomiting. Because of a circulatory failure with electrocardiographic ST changes and a slight elevation of ultra-sensible troponin, a coronary angiography was performed and found normal coronary arteries. Thoraco-abdominal CT scan revealed a large hiatal hernia causing a cardiac compression, and a left intraventricular obstruction showed by Doppler echocardiography. All signs resolved after fasting and gastric drainage.