Roemheld syndrome
Roemheld syndrome (RS), or gastrocardiac syndrome, or gastric cardiac syndrome or Roemheld–Techlenburg–Ceconi syndrome or gastric-cardia, was a medical syndrome first coined by Ludwig von Roemheld (1871–1938) describing a cluster of cardiovascular symptoms stimulated by gastrointestinal changes. Although it is currently considered an obsolete medical diagnosis, recent studies have described similar clinical presentations and highlighted potential underlying mechanisms. Symptoms and signs Symptoms can be as follows. They are periodic, and occur only during an "episode", usually after eating. Sinus bradycardia Difficulty inhaling Angina pectoris Left ventricular discomfort Premature heart beats (PVC / PAC) Tachycardia Fatigue Anxiety Uncomfortable breathing Poor perfusion Muscle pain (crampiness) Burst or sustained vertigo or dizziness Sleep disturbance (particularly when sleeping within a few hours of eating, or lying on the left side) Hot flashes Mechanical Mechanically induced Roemheld syndrome is characterized by pressure in the epigastric and left hypochondriac region. Often the pressure is in the fundus of the stomach, esophagus or distention of the bowel. It is believed this leads to elevation of the diaphragm, and secondary displacement of the heart. This reduces the heart's ability to fill and increases the contractility of the heart to maintain homeostasis. Neurological The cranium dysfunction mechanical changes in the gut can compress the vagus nerve at any number of locations along the vagus, slowing the heart. As the heart slows, autonomic reflexes are triggered to increase blood pressure and heart rate. This is complemented by gastro-coronary reflexes whereby the coronary arteries constrict with "functional cardiovascular symptoms" similar to chest-pain on the left side and radiation to the left shoulder, dyspnea, sweating, up to angina pectoris-like attacks with extrasystoles, drop of blood pressure, and tachycardia (high heart rate) or sinus bradycardia (heart rate below 60 bpm). Typically, there are no changes/abnormalities related in the EKG detected. This can actually trigger a heart attack for persons with cardiac structural abnormalities i.e. coronary bridge, missing coronary, and atherosclerosis. If the heart rate drops too low for too long, catecholamines are released to counteract any lowering of blood pressure. Catecholamines bind to alpha receptors and beta receptors, decreasing vasodilation and increasing contractility of the heart. Sustaining this state causes heart fatigue which results in fatigue and chest pain. Causes Gastroesophageal reflux disease Excessive gas in the transverse colon caused by: Lactose intolerance Abnormal gall bladder function and/or blood flow Gall stones Sphincter of Oddi dysfunction Hiatal hernia Cardiac bridge (Coronary occluding reflexes triggered by coronary reflexes) Enteric disease Aneructonia, the loss of the ability to belch (continuous or intermittent) Bowel obstruction (Less common, this usually leads to intense pain in short time) Acute pancreatic necrosis Diagnosis There is significant scope of misdiagnosis of Roemheld syndrome. Diagnosis of Roemheld syndrome usually starts with a cardiac workup, as the gastric symptoms may go unnoticed, the cardiac symptoms are scary and can be quite severe. After an EKG, Holter monitor, tilt test, cardiac MRI, cardiac CT, heart catheterization, EP study, echo-cardiogram, and extensive blood work, and possibly a sleep study, a cardiologist may rule out a