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Hiatal hernia mimicking heart problems
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  1. Wolfram Schummer
  1. Department of Anaesthesiology and Intensive Care Medicine, Friedrich-Schiller-Universitat Jena Medizinische Fakultat, Jena, Thuringia, Germany
  1. Correspondence to Dr Wolfram Schummer, wolfram.schummer{at}web.de, cwsm.schummer{at}gmx.de

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Description

A 73-year-old man presented to the emergency department with symptoms of acute coronary syndrome. Findings on examination were dyspnoea, chest tightness and a burning sensation behind the sternum.

On admission, 3 hours after the onset of symptoms, his 12-lead ECG showed a left bundle branch block. Cardiac enzymes revealed only marginally elevated creatine kinase, aspartate transaminase and lactate dehydrogenase levels; however, troponin I (<0.04 ng/mL) was increased to 17 and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) to 1472 pg/mL (73 year normal range: 10–220 pg/mL). Though the consulting cardiologist determined coronary angiography to be unnecessary at the time, the patient was promptly sent to the intensive care unit (ICU) for monitoring and for quick intervention, if needed.

At that time, further information was gathered from the patient and his family. Apparently, the symptoms had started during lunch. The patient had experienced these symptoms several times in the preceding months; this time, however, the complaints were extraordinary: chest tightness and dyspnoea increased dramatically in the supine position and decreased while upright. His previous medical history was relevant for obesity …

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