When the Stomach Rules the Heart

Hiatal hernia is a common condition; its exact prevalence is uncertain because of disagreement about its definition, but some sources suggest that it is present in more than 50% of individuals older than the age of 50 years (1). Cardiologists are most commonly involved in the care of patients with hiatal hernia because of the diagnostic challenge posed by gastroesophageal reflux in the differential diagnosis of chest pain. This entity also requires attention in relation to incidental findings on chest x-ray, difficulties in the performance of transesophageal echocardiography, and external compression of the left atrium causing an apparent left atrial mass (2,3). lthough an 84% prevalence of dyspnea has been reported in previous description of paraesophageal hernia repair on ulmonary function (4), dyspnea is not widely recognized as an mportant presentation of hiatal hernia. Indeed, cardiologists re all too familiar with the exercise implications of the tomach ruling the heart, and dyspnea in these circumstances is ften attributed to coexistent obesity, which is a commonly ssociated with hiatal hernia (5).