Hernia symptoms hide heart condition

Patient Stories

Thursday, June 9, 2022

Topics in this Post

• Heart Health
• Gastrointestinal Health

The motto for the City of Barron, Wisconsin, is: “Be kind. Be strong. Be together. Be Barron.” Nathan Emmons has embraced this motto in all that he does.

Over the span of 44 years, he has focused on bringing people together and caring for the community. He is a 17-year veteran of the Barron Police Department and founded the city’s K9 program. Before that, he was a pastor for 27 years, counseling families during times of joy and crisis.

While he was focusing on the community’s heart, his own heart was hiding a secret, life-threatening condition.

Concerning symptoms

In 2016, Nathan was working a night shift at the police department when he began experiencing chest pain. An otherwise healthy person, he was alarmed and went to the Emergency Department at Mayo Clinic Health System in Barron. The results from an echocardiogram and blood work were normal, and he was sent home to recover.

Nathan continued to have sporadic periods of chest pain, nausea and vomiting after periods of physical exertion.

“I would have chest pain and puking, but then it would be fine,” he says. “I found that if I drank water, it would relieve my symptoms. So I just carried water with me all the time.”

Hernia discovery

While he was controlling most of his symptoms, Nathan really wanted to get to the root of the problem. In 2019, Brad Kruger, a Family Medicine physician assistant and Nathan’s primary care provider, referred him to Gastroenterology for additional testing.

An endoscopy showed that Nathan had a hiatal hernia. This occurs when the upper part of the stomach budges through the large muscle separating the abdomen and chest.

“Hiatal hernias are common in Western countries. The frequency of hiatal hernias increases with age from 10% in patients younger than 40 to 70% in patients older than 70 years. However, only 9% have symptoms,” says Christian Mendez, M.D., a gastroenterologist at Mayo Clinic Health System in Barron and Eau Claire, Wisconsin. “Large hiatal hernia can cause heartburn, regurgitation of food or liquids into the mouth, difficulty swallowing, chest or abdominal discomfort, and early satiety.”

Over time, Nathan’s symptoms became more regular, and drinking water no longer provided relief.

“By the end of 2021, it was taking less effort to cause symptoms,” he says. “Even brushing snow off the car or running the K9 dog around cars for drug sniffs triggered chest pain and vomiting,” Nathan says. “I always had to carry a bottle of water with me.”

In January, Nathan decided to have Dr. Mendez reevaluate his hernia. After a repeat endoscopy, Dr. Mendez confirmed that Nathan had a small hiatal hernia and inflammation of the stomach lining.

Failing stress test

These conditions explained Nathan’s nausea and vomiting but not his chest pain. Dr. Mendez wanted to dig deeper.

“As the upper endoscopy findings didn’t explain his symptoms, I asked him about risks factors for heart disease, such as cholesterol, tobacco use and family history of cardiac disease. His family history of coronary artery disease was positive in several relatives,” says Dr. Mendez. “I immediately thought about an atypical presentation of coronary artery disease and recommended a stress test.”

While not excited about another test, Nathan was happy that Dr. Mendez focused on more than just his gastrointestinal symptoms.

“He had a genuine interest in me as a person. He asked questions about the location of my pain, to describe it and my overall health history,” says Nathan. “He took the time and thought outside of the box. At least outside of his specialty.”

On April 14, he traveled to Mayo Clinic Health System in Eau Claire for an exercise stress test that would show how his heart was working during physical activity.

“I wasn’t worried because, in my mind, I was dealing with a hernia — not a heart problem,” recalls Nathan. “But then I had a lot of pain during the stress test. I would score the pain higher than a 10, if possible. I failed it miserably.”

After the test, Joel Beachey, M.D., a Mayo Clinic Health System cardiologist, explained the results to Nathan and recommended immediate treatment.

“His stress test was markedly positive for ischemic changes, or findings that suggest decreased blood flow to the heart,” says Dr. Beachey. “When he exercised, he developed regional wall motion abnormalities, meaning that parts of his heart were not squeezing effectively. His ejection fraction — a marker of heart-pumping function — also decreased. This is a concerning warning sign of a significant blockage, usually in an important artery like the left main or left anterior descending coronary artery.”

He also explained that previous echocardiogram tests results appeared normal because they were completed while Nathan was at rest.

“If arteries are not completely blocked, patients may be getting normal blood flow during times when they are not active,” says Dr. Beachey. “Thus, the ischemic changes we look for on an echocardiogram may not be present.”

Treatment for blocked arteries

Dr. Beachey recommended that Nathan have a coronary angiogram right away and not wait until after the Easter holiday weekend. This procedure uses X-ray imaging to see if the heart’s blood vessels are restricted.

“In meeting with him and reviewing his history, I became concerned that his symptoms were becoming more unstable. He was describing rapid recent progression of symptoms with significant limitations with decreasing amounts of activity,” he says. “While he had been having symptoms for months, the progression concerned me about his risk for an acute coronary syndrome event soon. I recommended that we proceed with coronary angiogram, and, thankfully, we were able to arrange for an angiogram the following day.”

On April 15, Nathan’s wife lined up someone else to play the organ during Good Friday church service so she could drive him to Eau Claire for the coronary angiogram. Mayo Clinic Health System cardiologist D. Fearghas O’Cochlain, M.D., injected dye into Nathan’s vessels and discovered the source of his discomfort: significant blockages in four major arteries of his heart.

“The angiogram showed that Mr. Emmons had severe coronary artery disease involving multiple vessels,” says Dr. O’Cochlain. “He had 90% blockages in the proximal and midleft anterior descending arteries, plus left circumflex artery. Mr. Emmons also had a 70% blockage of his first diagonal artery.”

Dr. O’Cochlain placed four stents in the narrowed arteries to increase blood flow around Nathan’s heart. This included a stent in the left anterior descending artery, sometimes called the “widow-maker.”

“The left anterior descending artery provides blood supply to a large portion of the left ventricle,” explains Dr. Beachey. “Heart attacks involving this artery have the worst prognosis among all types of heart attacks and have the highest rates of sudden death, due to the significant portion of heart muscle that can be involved. “

When Nathan woke up in recovery, he learned about the extent of the blockages. He was relieved the care team was able to restore blood flow.

“To say I was shocked would be an understatement,” he says. “I eat healthy and take supplements that are good for my heart, so I didn’t expect it to be that bad.”

Dr. Beachey explains Nathan didn’t have any of the typical risk factors for artery blockages like high blood pressure, high cholesterol, smoking or diabetes.

“Mr. Emmons had no specific risk factors, aside from family history. He has been otherwise healthy and active without prior known significant medical issues,” says Dr. Beachey. “I suspect his coronary disease is strongly genetically influenced, as he reported a family history of heart attacks.”

Dr. O’Cochlain explains that symptoms of heartburn, acid reflux and chest pain overlap due to reduced blood flow to the heart. This can lead some people to downplay symptoms and not seek medical care.

“Many people interpret the symptom ‘chest pain’ as a sharp localized discomfort similar to a knife. However most do not experience cardiac discomfort in this way,” he says. “It’s often pressure, burning, poorly localized discomfort or a cramp. Because it is not what they think of as ‘pain,’ people may either dismiss it or attribute it to something else, such as heartburn.”

Welcome visit during recovery

Nathan got another surprise while in the recovery area: a visit from Dr. Mendez.

“I wanted to celebrate with him and his wife,” says Dr. Mendez. “I knew he was coming for his cardiac intervention, and I like to follow up with my patients after referring to other specialties.”

This gesture meant a lot to the Emmons family.

“He had no other reason to be there, except that he cared,” Nathan says. “It meant a lot to me and my wife that he checked in on us. When she realized who he was, she gave him a big hug and told him thank you.”

Next steps

After the angiogram and stent placements, Nathan was able to recover at home. Shortly after, he began cardiac rehabilitation to rebuild the strength and stamina of his heart.

Once recovered, he will discuss with Dr. Mendez treatment options for his hiatal hernia. Nathan is hoping to get the green light to spend time golfing and fishing this summer.

Reflecting on the last months, Nathan says he feels blessed to have met Dr. Mendez and to have received expert, timely care from the Cardiology team.

“Had he not recommended the stress test, I don’t want to think about what could have happened. Any one of the times that I pushed through the pain before could have easily been my last day,” he says. “God kept me here for a reason.”

Topics in this Post

• Heart Health
• Gastrointestinal Health

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Treatment and when to seek help

People with a hiatal hernia can experience heartburn, often after eating. This can cause an individual to experience a painful, burning feeling in their chest. When the hernia is larger, it can also cause pain or pressure in the chest if it affects the heart and lungs.

A hiatal hernia is where the upper part of the stomach, or another internal organ, bulges through the opening in the diaphragm, called the hiatus.

The diaphragm is a thin muscle separating the abdomen and the chest. It helps stop acid from coming up into the esophagus, or food pipe. A hiatal hernia makes it easier for acid to reach the esophagus.

This article looks at what chest pain from a hiatal hernia feels like, whether chest pain signifies that a hernia is worsening, treatment options, and when to contact a doctor.

Hiatal hernia can cause chest pain and has associations with the following conditions.

Gastroesophageal reflux disease (GERD) and heartburn

In many cases, chest pain from a hiatal hernia has links to acid and the contents of the stomach traveling up to the esophagus.

This is called gastroesophageal reflux disease (GERD) and can cause a person to experience heartburn. Heartburn feels like a burning sensation in the middle of the chest and can cause a foul, acidic taste in the mouth.

According to a 2019 article, the chest pain related to GERD can feel similar to the pain associated with a heart attack. The pain can also occur without heartburn.

Additionally, GERD can cause the muscles in the esophagus to spasm. This can also cause a person to experience chest pain that they could mistake for a heart attack.

Heart and respiratory system

Hiatal hernias can affect the respiratory system, which may also cause pain or pressure in the chest.

As the hernia enlarges and takes up more space, it can compress the arteries in the heart and lungs. This may cause a part of the lung to collapse, which can lead to the following:

• trouble breathing
• an intense tightness in the chest
• shortness of breath

Hiatal hernias may also cause pressure on the heart, called tamponade. The hernia can compress the heart, causing shortness of breath and chest discomfort.

Chest pain can signify a strangulated or worsening hiatal hernia.

A hernia becomes strangled when the blood supply to the hernia is cut off.

A doctor may suspect that a hiatal hernia is strangulated if a person has severe chest or upper abdominal pain, usually after a meal. In this scenario, individuals may also experience retching and vomiting.

If people suspect their hernia is worsening, they should contact a doctor.

Depending on the severity of a hiatal hernia, a person may not require medical treatment.

A 2022 article notes that while hiatal hernias are common and affect up to 60% of individuals over 50 years of age, only 9% experience symptoms. People who do not experience symptoms do not require medical treatment.

Home treatment and management

The following can help manage the symptoms of a hiatal hernia:

• stopping smoking, if applicable
• eating small meals
• avoiding oily or fried foods
• avoiding caffeine
• avoiding alcohol
• maintaining a moderate weight
• taking over-the-counter (OTC) antacids
• being upright while eating
• eating at least 3 hours before going to bed

Medical treatment

If a person experiences symptoms of a hiatal hernia, such as GERD, they may require medical treatment.

This may involve using proton pump inhibitors, which are medications to treat heartburn, acid reflux, GERD, and stomach ulcers. Doctors may also recommend surgical procedures.

Procedures and surgeries include:

• Transoral incisionless fundoplication: This procedure does not involve incisions. A doctor places an endoscope down the throat and into the esophagus to tighten it. They then wrap parts of the stomach — the cardia and the fundus — around the esophagus.
• Endoluminal fundoplication: A doctor places an endoscope, a tube that attaches to a camera and light, down the throat. They then tighten the area where the esophagus joins the stomach to prevent acid from flowing into the esophagus.
• Endoscopic anterior fundoplication with the Medigus Ultrasonic Surgical Endostapler: A doctor uses surgical staples to attach the fundus to the esophagus. This procedure stops acid reflux.
• Nissen fundoplication: Surgeons can perform this procedure laparoscopically, which means through tiny incisions. They insert a laparoscope, a tube with a camera and light attached, to repair the hernia and tighten the stomach opening.
• Open surgery: This involves the surgeon making a larger incision into the abdomen. The surgeon pulls the stomach up into the abdominal cavity and wraps the fundus around the lower part of the food pipe. This prevents acid from leaking up into the esophagus.

Someone should contact a doctor if they experience chest pain, whether they believe it is due to a hiatal hernia. Chest pain may indicate a serious medical condition, such as a heart attack.

Individuals should also contact a doctor if their symptoms:

• persist for longer than 3 weeks
• do not resolve from using OTC antacids
• worsen

A hiatal hernia can cause a person to experience chest pain. One of the most common presentations of a hiatal hernia is GERD. GERD can cause a person to experience heartburn, causing discomfort and pain in the chest.

It can also cause the esophageal muscles to spasm, resulting in chest pain that feels similar to chest pain relating to a heart attack.

Other causes of chest pain from a hiatal hernia are pressure on the lungs or chest due to the expansion of the hernia. These may cause shortness of breath and chest discomfort.

Severe chest pain, along with some other symptoms such as retching and fever, may indicate that a hiatal hernia is strangulated.

This is a medical emergency, and anyone with these symptoms should seek immediate emergency medical assistance.

People should also seek medical attention immediately if they experience chest pain. This is because chest pain can be a sign of a heart attack.

Diaphragmatic hernia | Morozovskaya DGKB DZM

Diaphragmatic hernia is a developmental anomaly characterized by the presence of a congenital defect of the diaphragm, through which, in the prenatal period, the abdominal organs (intestinal loops, stomach, spleen, sometimes part of the liver) move into the chest. The incidence of this developmental anomaly is 1 case per 2200 newborns (P.Puri, M.Hollwarth 2009). There are left-sided and right-sided diaphragmatic hernia, false and true, as well as eventration of the diaphragm. There are hernias of the diaphragm itself and hernias of the natural openings of the diaphragm (hiatal hernia, paraaortic). With congenital diaphragmatic hernia, there are combined anomalies in the development of other organs and systems (malformations of the nervous system, heart defects, malrotation).

Currently, the malformation is diagnosed antenatal at 18-20 weeks of fetal development. With ultrasound of the fetus in the chest, the abdominal organs are visualized, the mediastinum is displaced to the healthy side, polyhydramnios is noted.

Clinical symptoms develop a few minutes after birth as a manifestation of respiratory failure (cyanosis, rapid breathing, retraction of the sternum). It may be asymptomatic for several months or even years. The earlier the clinic of diaphragmatic hernia appears, the worse the prognosis of this disease. If a diaphragmatic hernia is suspected, immediate hospitalization in a specialized hospital is necessary.

Diagnosis of diaphragmatic hernia after birth is made on the basis of clinical examination (difficulty breathing, cyanosis, shift of heart sounds to the healthy side, weakening or absence of breathing on the side of the lesion, sunken abdomen), chest x-ray in two projections, in which chest intestinal loops, the dome of the diaphragm is not determined, the mediastinum is displaced in the opposite direction, in the abdominal cavity, the presence of gas in the intestinal loops is sharply reduced or absent.

If the diagnosis is difficult, an x-ray of the gastrointestinal tract is performed with the introduction of water-soluble contrast, in which intestinal loops are detected penetrating through the diaphragm into the chest.

Preoperative preparation is carried out in the intensive care unit. Insert a gastric tube and decompress the stomach, intubate the trachea, and provide adequate ventilation. Stabilize hemodynamic parameters.

After the child’s condition is stabilized, surgery is performed. Surgical treatment consists in moving the organs back into the abdominal cavity and suturing the diaphragm defect. In most cases, the defect can be sutured with local tissue. With a significant size of the defect, inserts made of various synthetic materials are used. After the operation, the child is in the intensive care unit, receiving the necessary treatment to maintain vital functions. The prognosis of this disease largely depends on the degree of underdevelopment of the lungs.

The current preference is for thoracoscopic surgery. This technique is less traumatic, promotes accelerated recovery in the postoperative period and provides a good cosmetic result.

Hernia, symptoms, diagnosis and treatment | Alpha

Esophageal hernia: symptoms and treatment

A hiatal hernia (hiatal hernia) is a condition in which the upper portions of the stomach and part of the esophagus enter the chest area through an opening in the diaphragm. Diaphragmatic hernia of the esophagus causes significant discomfort and interferes with a person in everyday life. Over time, the disease can provoke dangerous complications, therefore, it requires serious treatment.

Causes of disease

In childhood, a hernia of the diaphragm of the esophagus occurs due to anatomical pathologies of the formation of the fetus. The child has a displacement of the cardial part of the stomach into the chest cavity.

Possible causes of hernia of the esophagus in adults:

• weakness of the ligamentous apparatus of the digestive system;
• inflammatory diseases of the stomach: ulcer, chronic gastroduodenitis, pancreatitis, etc.;
• pathology of the esophagus: burns of the mucosa, esophagitis, varicose veins, etc.;
• injuries of the gastrointestinal tract;
• damage caused by a prolonged increase in pressure in the abdominal cavity, for example, during heavy physical exertion;
• obesity, constipation, flatulence;
• tumors.

Diaphragmatic hernia classification

• Sliding (axial) . The fundus of the stomach and part of the esophagus slide freely into the chest cavity. Axial hernias are the most commonly diagnosed. The risk of infringement is minimal.
• Perioesophageal (paraesophageal) . Less common is a pathology in which the esophagus remains in place, and the fundus of the stomach and other abdominal organs protrude through the opening of the diaphragm. Paraesophageal hernias are often infringed, therefore, as a rule, they require surgical treatment.
• Mixed . Hernia of the esophagus of the stomach has signs of both types described above.
• Acquired short esophagus . Pathology occurs as a result of trauma and inflammatory diseases. The stomach is drawn into the mediastinum through the diaphragmatic opening.

Esophageal hernia stages

• I – the abdominal esophagus is displaced into the mediastinum, the fundus of the stomach is located close to the diaphragm.
• II – the bottom and cardia of the stomach are located in the esophagus.
• III – the stomach and part of the esophagus are displaced into the mediastinum.

Hernia symptoms

The disease can proceed for many years without severe symptoms. Most often, pathology is diagnosed during a routine examination or medical examination.

There are several non-specific symptoms of a hernia of the esophagus, in the event of which it is necessary to consult a gastroenterologist:

• Heartburn, which is aggravated by physical exertion, bending over.
• Pain behind the sternum, the cause of which is the compression of displaced organs.
• Belching with a sour or bitter taste.
• Dysphagia after swallowing food quickly or eating fried food.
• Hiccups, which may increase to vomiting.

Signs of a hernia of the esophagus are often confused with cardiac symptoms. The patient may experience persistent cough, shortness of breath, tachycardia, blanching of the skin after eating. Pain with a hernia of the esophagus can be localized in the region of the heart.

Disease diagnosis

The most informative are instrumental diagnostic methods:

• Barium X-ray . Pictures are taken in several projections. Radiography allows you to detect the protrusion of organs in the esophageal opening of the diaphragm and assess the severity of the disease.
• Computed tomography . According to the pictures, the doctor determines the size, localization of the defect. The CT image clearly shows the blood vessels and contents of the hernia.
• Fibroesogastroscopy . A thin tube with a video camera is pushed into the esophagus. The doctor on the screen sees the mucous membrane of the internal organs, can detect inflamed areas, ulcers, scars and other defects.
• ultrasound . The examination determines the degree of displacement of the boundaries of the mediastinum, heart, measure the defect of the diaphragm.
• Esophageal manometry . An examination is prescribed to assess the performance of the esophageal sphincters. Esophageal manometry helps not only in diagnosis, but also in evaluating the effectiveness of prescribed therapy.

Treatment

At stages 1 and 2, conservative treatment of esophageal hernia is indicated. To reduce heartburn, drugs are prescribed that reduce the level of acidity in the stomach, antacids. It is possible to take medications that stimulate the peristalsis of the stomach.

Proper nutrition plays an important role in treatment. The patient should divide the daily norm into 5-6 small portions, have dinner no later than 2 hours before bedtime. Fried, spicy, fatty foods, alcoholic and carbonated drinks are excluded from the diet. The menu is based on vegetable soups, boiled fish, meat, kissels, cereals, fruits. Normalization of nutrition with a hernia of the esophagus allows you to almost completely get rid of unpleasant symptoms.

In severe clinical cases, surgery is indicated. The task of the surgeon is to eliminate reflux and reduce the esophageal opening in the diaphragm. Rehabilitation after surgery takes several days. To prevent relapse, patients are advised to follow a diet, give up bad habits and avoid physical activity.

What is dangerous hernia of the esophagus without treatment:

• infringement of internal organs;
• increased reflux to vomiting;
• development of ulcers, erosion in the digestive tract;
• occurrence of internal bleeding.

Diagnosis and treatment of esophageal hernia in Nizhny Novgorod

The clinic “Alfa Health Center” invites you to undergo a comprehensive examination of the gastrointestinal tract. Our specialists will make a diagnosis, prescribe competent treatment, and help get rid of the uncomfortable manifestations of the disease. The phone number for registration is listed on the website.