Journal
AMERICAN JOURNAL OF EMERGENCY MEDICINE
Volume 49, Issue -, Pages 265-267Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.ajem.2021.06.038
Keywords
Hiatal hernia; Heart failure; Left atrium; Compression; Shortness of breath
Categories
Ask authors/readers for more resources
The case study presented a 57-year-old woman with isolated shortness of breath who was diagnosed with symptomatic hiatal hernia causing cardiac compression. After upper gastrointestinal endoscopy and surgical repair, the patient was discharged in stable condition.
Symptomatic hiatal hernia (HH) is most often revealed by gastroesophageal reflux disease, but there are atypical presentations some of which are life-threatening. We report the case of a 57-year-old woman brought to the emergency department with isolated shortness of breath for 24 h. Initial explorations revealed unexplained hyperlactatemia (6.4 mmol/L) without clinical or biological evidence of hypovolemia, distributive, obstructive or cardiogenic shock. Two hours after admission, we observed a decreased of blood pressure and an increase of lactate level to 7.9 mmol/L. A bedside echocardiography revealed an extra-cardiac left atrial compression and thoracoabdominal computed tomography showed a large sliding HH compressing the left atrium. After an upper gastrointestinal endoscopy permitting the aspiration of gastric contents, a repair surgery was performed without complications and patient was discharge three days later. Emergency physicians should be aware that HH can be a rare cause of cardiac symptoms by heart compression and certainly use echocardiography for unexplained hemodynamic failure. (C) 2021 Elsevier Inc. All rights reserved.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available