SHM Converge Scientific Abstract ePoster Gallery-Hiatal Hernias: The Great Imitator and Instigator of Cardiac Dysfunction

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This case highlights a rare but important presentation of a large type III hiatal hernia causing significant cardiopulmonary effects in a 99-year-old woman. She arrived at the emergency department with new post-prandial abdominal pain, nausea, and vomiting. Her medical history included atrial fibrillation, HFpEF, diabetes, and hypertension. Exam showed an irregular rhythm and chronic leg edema, while labs revealed mildly elevated troponin, markedly elevated pro-BNP, and acute kidney injury.<br /><br />Imaging with chest X-ray and CT demonstrated a large hiatal hernia with diffuse cardiac compression. Echocardiography showed worsening right-sided heart strain, including right atrial and right ventricular dilation, pulmonary hypertension, and moderate-to-severe tricuspid regurgitation. Although her EKG did not show ischemia, her presentation and prior episodes of dyspnea suggested that the enlarging hernia was contributing to her cardiac dysfunction.<br /><br />The discussion emphasizes that hiatal hernias, especially types II-IV, can cause symptoms beyond gastrointestinal complaints. Due to mass effect on the left atrium and pulmonary veins, they may mimic or worsen heart failure, atrial fibrillation, pulmonary edema, pleural effusions, and right-sided cardiac dysfunction. Symptoms may even occur after meals.<br /><br />Her condition improved with nasogastric decompression, IV fluids, and supportive care, which resolved the prerenal AKI. A barium study showed no obstruction, so surgery was deferred because of her age, absence of volvulus or obstruction, and patient preference. She was eventually discharged on a regular diet.<br /><br />Overall, the case illustrates that large hiatal hernias can be “great imitators” of cardiac disease and should be considered in patients with unexplained dyspnea, arrhythmias, or worsening heart failure, particularly when symptoms are meal-related.

Asset Subtitle

Mark Liotta

Meta Tag

Author List Alan A. Kubey, Julia Palecki, Mark Liotta, Sunidhi Ramesh

Category Clinical Vignettes

Concept Hiatal Hernia

Concept Type III Hiatal Hernia

Concept Cardiopulmonary Findings

Concept Cardiac Compression

Concept Compressive Mass Effect

Distinguished Non-Finalist

Presenter Organization Thomas Jefferson University Hospital

Presenting Author Mark Liotta

Track Adult

Keywords

hiatal hernia

type III hernia

cardiopulmonary compression

right heart strain

atrial fibrillation

heart failure

pulmonary hypertension

post-prandial symptoms

nasogastric decompression

elderly patient

Hiatal Hernia

Type III Hiatal Hernia

Cardiopulmonary Findings

Cardiac Compression

Compressive Mass Effect