American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
Open Access
Journal Browser
Go
American Journal of Medical Case Reports. 2017, 5(4), 89-93
DOI: 10.12691/ajmcr-5-4-4
Open AccessArticle

Syncope Due to Intracavitary Left Ventricular Obstruction Secondary to Giant Esophageal Hiatus Hernia

Kazuhito Hirata1, , Yuji Shimabukuro1, Takanori Takahashi1 and Minoru Wake1

1Division of Cardiology, Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa, Japan

Pub. Date: May 12, 2017

Cite this paper:
Kazuhito Hirata, Yuji Shimabukuro, Takanori Takahashi and Minoru Wake. Syncope Due to Intracavitary Left Ventricular Obstruction Secondary to Giant Esophageal Hiatus Hernia. American Journal of Medical Case Reports. 2017; 5(4):89-93. doi: 10.12691/ajmcr-5-4-4

Abstract

Esophageal hiatus hernia has been known to cause symptoms of congestive heart failure or syncope after meal due to compression of the heart, mainly the left atrium. However, compression of the left ventricle resulting in syncope has never been reported. Seventy-one year old woman developed syncope after taking a lunch. A chest roentgenogram showed possible mass lesion behind the heart. An echocardiogram revealed a mass lesion posterior to the left ventricle, resulting in “banana-shaped” deformity. A CT scan revealed a giant esophageal hiatus hernia which compressed the left ventricle. Cardiac catheterization revealed marked pressure gradient in the left ventricle suggestive of intracavitary obstruction after isoproterenol infusion. Left ventricular compression due to enlarged giant hiatus hernia after meal resulted in intracavitary obstruction of the left ventricle, causing syncopal episode in this particular patient. Dehydration and diastolic dysfunction may also have contributed.

Keywords:
esophageal hiatus hernia left ventricular obstruction syncope

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Maekawa T, Suematsu M, Shimada T, Go M, Shimada T. Unusual swallow syncope caused by huge hiatal hernia. Intern Med 2002; 41: 199-201.
 
[2]  Naoum C, Falk GL, Ng ACC et al. Left atrial compression and the mechanism of exercise impairment in patients with large hiatal hernia. J Am Coll Cardiol. 2011;58(15):1624-1634.
 
[3]  Nakabayashi K, Hirata T, Oka T. Left atrium compression due to oesophageal dilatation can induce acute heart failure. BMJ case rep. 2015.
 
[4]  Mitra S, Ludka T, Rezkalla SH et al. Swallow syncope. Clinical Medicine and Research: 9; 125-9.
 
[5]  Neuman L, Poulton B, Ridley S et al. Life threatening complications of hiatus hernia. Anaesthesiology 1999; 54: 93-4.
 
[6]  Hashimoto Y, Reid CL, Gardin JM. Left ventricular cavitary geometry and dynamic intracavitary left ventricular obstruction during dobutamine stress echocardiography. Am J Card Imaging 1996; 10: 163-9.