A case report of a giant hiatal hernia mimicking an ST-elevation myocardial infarction

Maria Rubini Gimenez; Leander Gonzalez Jurka; Michael J Zellweger; Philip Haaf

doi:10.1093/ehjcr/ytz138

A case report of a giant hiatal hernia mimicking an ST-elevation myocardial infarction

Eur Heart J Case Rep. 2019 Sep 1;3(3):ytz138. doi: 10.1093/ehjcr/ytz138.

Authors

Maria Rubini Gimenez¹, Leander Gonzalez Jurka², Michael J Zellweger¹, Philip Haaf¹

Affiliations

¹ Department of Cardiology, University Hospital Basel and University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
² Department of Pneumology, University Hospital Basel and University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland.

Abstract

Background: Acute coronary syndrome (ACS) can be a life-threatening condition. However, identification of patients with ACS can be challenging, especially among women, and clinical presentation can often overlap with other medical entities.

Case summary: A 61-year-old woman with a history of stable bronchial asthma presented with worsening dyspnoea for spiroergometry. During bicycle exercise testing, she developed acute chest pain and her electrocardiogram showed significant ST-segment elevations. High-sensitivity cardiac troponin was elevated and a coronary angiography was performed showing normal coronary arteries. Cardiac magnetic resonance imaging showed no signs of myocardial infarction, myocarditis or Takotsubo cardiomyopathy but the incidental finding of a giant hiatal hernia impeding the filling of the left atrium. The giant hernia was surgically corrected, and the patient's exertional dyspnoea fully relieved during follow-up.

Discussion: Hiatal hernia might compress cardiac structures, cause exertional dyspnoea and mimic ST-elevation myocardial infarction. 10.1093/ehjcr/ytz138_audio1 ytz138_audio1 6074443146001.

Keywords: Acute coronary syndrome; Cardiac compression; Case report; Electrocardiogram; Giant hiatal hernia; ST-elevation myocardial infarction.