Article Details

Background: Hiatus hernia is linked to cardiac complications such as pulmonary edema and postprandial syncope. In severe cases, extracardiac compression can simulate cardiac tamponade physiology, impairing diastolic ventricular filling and reducing coronary perfusion pressure, potentially precipitating myocardial ischemia.
Case Summary: We present a case of a large hiatus hernia presenting with acute coronary syndrome without coronary atherosclerosis. The treatment strategy was to decompress the hernia and augment intravascular fluid volume.
Discussion: Compression from a large hiatus hernia can cause tamponade physiology, as documented in the literature following cardiac surgery. Elevated left ventricular filling pressure during tamponade leads to ischemia, progressing from the subendocardium to the subepicardium. In this case, sepsis and hypotension further reduced blood flow, worsening ischemia. This case highlights a rare cardiac complication of hiatus hernia and emphasizes the importance of understanding its pathophysiology to effectively address treatment challenges.

Keywords: Hiatus hernia; Myocardial infarction; Cardiogenic shock; Tamponade