Syncope Upon Swallowing Caused by an Esophageal Hiatal Hernia Compressing the Left Atrium: A Case Report

Abstract

We describe a patient with syncope associated with swallowing. This syncope was caused by transient compression of the left atrium (LA) by an esophageal hiatal hernia. Two-dimensional echocardiography demonstrated a hyperechoic mass compressing the LA from the posterior. With air insufflation of the esophagus, compression of the LA by this hernia sac was seen to increase. Pulsed and color Doppler echocardiography revealed greatly decreased velocity of blood flowing into the LA and left ventricle (LV). Thus, marked compression of the LA by an esophageal hiatal hernia can cause syncope by impeding blood flow from the LA to the LV. Echocardiography proved highly useful in diagnosis.

Swallow Syncope: A Case Report and Review of the Literature

“…For instance, left atrial compression should be ruled out by echocardiography. 23 A large hiatal hernia can cause extrinsic compression of the left atrium during meals and impede cardiac output leading to hypotension and syncope. These patients can get relief of their symptoms by surgical repair of the hernia.…”

“…These patients can get relief of their symptoms by surgical repair of the hernia. 23,24 A pacemaker would not provide any benefit because bradycardia is not involved.…”

Long-Term Cardiovascular Symptoms in a Patient with a Large Diaphragmatic Hernia

“…The patient had normal coronary artery. The large hernial sac may exert pressure on the surrounding tissues in the chest and lead to recurrent pneumonia, atelectasis, and compression of the heart [5,6]. These may be the cause of long-term obstructive symptoms in this patient.…”

“…The differentiation of cardiac versus noncardiac chest pain can be an especially difficult thing when patients present with symptoms of CAD [3]. Acute chest pain could be secondary to spontaneous gastric mesenteric vessel rupture due to a non-strangulated hiatal hernia [4]. The patient's chief complaint was CAD.…”

Paroxysmal Postprandial Atrial Fibrilation Suppressed by Laparoscopic Repair of a Giant Paraesophageal Hernia Compressing the Left Atrium

“…Besides causing regurgitation and heartburn due to accompanying GERD, it may present with a wide spectrum of manifestations mimicking those of cardiovascular pathology such as postprandial syncope, angina-like chest pain, recurrent dyspnea and acute heart failure due to HH induced cardiac compression [11][12][13]. Further, HH may simulate the appearance of an intra-atrial mass on transthoracic echocardiography [13,14].…”