Can a hiatal hernia cause tachycardia?

Can Hiatal Hernia Cause Tachycardia?

Yes, hiatal hernia can cause tachycardia and other cardiac arrhythmias, particularly in cases of large hernias, though this is an uncommon presentation that requires clinical correlation to exclude other cardiac causes.

Mechanism and Clinical Evidence

The association between hiatal hernia and cardiac arrhythmias, including tachycardia, is well-documented in the literature, though the exact mechanism remains incompletely understood. The anatomical proximity of a herniated stomach to the heart creates mechanical compression and vagal stimulation that can trigger arrhythmias 1, 2.

Types of Arrhythmias Associated with Hiatal Hernia

• Tachyarrhythmias documented include supraventricular tachycardia, atrial fibrillation, atrial flutter, and ventricular tachycardia 1, 2
• Bradyarrhythmias including complete heart block have been reported, though these are rarer 3
• Premature ventricular contractions can occur, particularly with large hernias, and may resolve after surgical correction 1

Size Matters

Large or giant hiatal hernias are more likely to cause cardiac symptoms than smaller ones:

• Giant hernias can cause postprandial nonsustained ventricular tachycardia due to mechanical distortion of the heart 2
• Large intrathoracic hernias occupy significant thoracic space, directly impinging on the left atrium and cardiac structures 3, 4
• The herniated stomach can create an air-fluid level visible on chest radiography that may be mistaken for cardiomegaly 2

Age and Sex Considerations

The association appears particularly strong in younger patients:

• In patients under 55 years, the occurrence of atrial fibrillation was 17.5-fold higher in men with hiatal hernia and 19-fold higher in women compared to the general population 4
• This suggests that hiatal hernia should be considered in the differential diagnosis of arrhythmias in younger patients without traditional cardiac risk factors 4

Clinical Recognition

When to Suspect Hiatal Hernia as the Cause

Consider hiatal hernia in patients presenting with:

• Tachycardia or arrhythmias accompanied by gastrointestinal symptoms (GERD, heartburn, dysphagia, postprandial symptoms) 1, 2
• Postprandial timing of cardiac symptoms, suggesting mechanical compression from gastric distension 2
• Chest pain that may mimic angina but occurs with eating or positional changes 2
• Young patients with arrhythmias lacking traditional cardiovascular risk factors 4

Important Caveat

While tachycardia can be a sign of strangulated hernia (a surgical emergency), this typically presents with fever, continuous abdominal pain, and signs of systemic inflammatory response syndrome (SIRS) 5. This is distinct from the chronic arrhythmias caused by mechanical compression from non-strangulated large hernias.

Diagnostic Approach

• Holter monitoring can document the temporal relationship between symptoms and arrhythmias 2
• Imaging with fluoroscopy (biphasic esophagram or upper GI series) is the most useful test for diagnosing hiatal hernia and determining its size 5
• CT imaging can demonstrate the hernia's size, position, and relationship to cardiac structures 2, 3

Management Implications

• Acute management of arrhythmias caused by large hernias may require nasogastric decompression to reduce gastric distension and mechanical compression 3
• Surgical repair of large symptomatic hernias can resolve associated arrhythmias, with documented resolution of PVCs and ventricular tachycardia post-operatively 1, 2
• Medical management of GERD should be optimized, as gastroesophageal reflux itself may contribute to arrhythmogenesis 1

Clinical Pitfall

Do not assume all cardiac symptoms in patients with known hiatal hernia are hernia-related—standard cardiac workup remains essential to exclude primary cardiac disease, particularly in older patients with cardiovascular risk factors 2, 4.