Key result
Sliding hiatus hernia causes recurrent acute HF via recumbent left atrial compression.
Why the study?
Recurrent nocturnal acute pulmonary oedema can occur with normal cardiac function, and the underlying cause may be unclear without detailed imaging and hemodynamic assessment.
Case Report (n=1)
A sliding hiatus hernia can cause recurrent acute heart failure due to external compression of the left atrium when recumbent.
Answers are grounded in this paper and cite their sources.
May prompt evaluation for hiatus hernia in unexplained positional HF; hypothesis-generating for prevalence and intervention.
The case is reported of a 75 year old woman who presented with recurrent nocturnal episodes of acute pulmonary oedema. The cause was uncertain as she had normal cardiothoracic ratio on chest radiography and normal left ventricular systolic and diastolic function by transthoracic echocardiogram. Another transthoracic echocardiogram was repeated when she was recumbent for an hour and had a full stomach. It showed a striking finding of severe left atrial compression by an external structure. Computed tomography of the thorax showed an intrathoracic mass behind the left atrium causing external compression of the left atrium suggestive of a sliding hiatus hernia. Cardiac catheterisation confirmed the diagnosis by showing a pronounced rise of pulmonary capillary wedge pressure in the recumbent position compared with the sitting up position.
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Jim et al. (2005) conducted a case report in Recurrent acute heart failure (n=1). Sliding hiatus hernia was evaluated. A sliding hiatus hernia caused severe left atrial compression and recurrent acute heart failure in the recumbent position, confirmed by elevated pulmonary capillary wedge pressure.
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