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Left atrial compression by a large hiatal hernia: a rare cause of cardiac dysfunction

Abstract : Symptomatic hiatal hernia (HH) is most often revealed by gastroesophageal reflux disease, but there are atypical presentations some of which are life-threatening. We report the case of a 57-year-old woman brought to the emergency department with isolated shortness of breath for 24 hours. Initial explorations revealed unexplained hyperlactatemia (6.4 mmol/L) without clinical or biological evidence of hypovolemia, distributive, obstructive or cardiogenic shock. Two hours after admission, we observed a decreased of blood pressure and an increase of lactate level to 7.9 mmol/L. A bedside echocardiography revealed an extra-cardiac left atrial compression and thoracoabdominal computed tomography showed a large sliding HH compressing the left atrium. After an upper gastrointestinal endoscopy permitting the aspiration of gastric contents, a repair surgery was performed without complications and patient was discharge three days later. Emergency physicians should be aware that HH can be a rare cause of cardiac symptoms by heart compression and certainly use echocardiography for unexplained hemodynamic failure.
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https://hal.sorbonne-universite.fr/hal-03274562
Contributor : Gestionnaire Hal-Su <>
Submitted on : Wednesday, June 30, 2021 - 11:23:52 AM
Last modification on : Tuesday, July 13, 2021 - 3:29:28 AM

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Marianne Apard, Célina Pognonec, Youri Yordanov, Pierre-Clément Thiebaud. Left atrial compression by a large hiatal hernia: a rare cause of cardiac dysfunction. American Journal of Emergency Medicine, Elsevier, 2021, 49, pp.265-267. ⟨10.1016/j.ajem.2021.06.038⟩. ⟨hal-03274562⟩

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