The cardiovascular effects of large hiatal hernias: a narrative review of cases and studies.

Hiatal hernia (HH) is a common disease in the general population. It is often asymptomatic, but if it does present clinical manifestations, these are usually gastrointestinal. Gastroesophageal reflux is the main symptom that accompanies it. Depending on the severity of the hernia, it is classified into several subtypes from I-IV. Especially, IV type (giant HH) can lead to various cardiopulmonary symptoms with several degrees of severity. It is necessary to keep this possibility in mind among the various differential diagnoses that may occur in this clinical setting. The current paper aims to review the literature on classic and novel information on the HH - cardiovascular system relationship. Epidemiological data, physiological aspects of the heart compressed by HH, cardiovascular symptoms, electrocardiographic changes, echocardiographic alterations and clinical implications are discussed.

Normally, the stomach and the heart are not in direct contact because they are in different cavities, the thorax and the abdomen, respectively. When part of the stomach moves toward the chest through the diaphragm, we say there is a hiatal hernia (HH). Most of the time the HH symptoms are mild and clearly digestive. In severe cases, surgical repair of the HH is required. Even in these circumstances, digestive symptoms continue to be the most frequent. However, some patients present cardiovascular symptoms and few or no digestive symptoms. This easily creates diagnostic confusion, which leads to incorrect treatments and unnecessary expenses. In extreme cases, as seen in giant HH, the degree of cardiovascular involvement is very serious. There are documented cases that have suffered cardiac arrest, arrhythmias of different types and symptoms like classic acute myocardial infarction. It is required that clinical doctors and surgeons are aware that this complication exists. Only with this in mind can a timely diagnosis be achieved. Some emergency measures have been saving, gastric decompression with a tube being the most important. The main mechanism that explains the serious cardiovascular consequences of giant HH is cardiac compression. The dissemination of this knowledge can help save lives.

Caracterización de la mortalidad por infarto agudo de miocardio con elevación del segmento ST en el Hospital Arnaldo Milián Castro (Cuba): Estudio de 6 años / Characterization of mortality due to acute myocardial infarction at the Hospital Arnaldo Milián Castro (Cuba): A 6-year study

RESUMEN Introducción: Las enfermedades cardiovasculares aportan el mayor número de defunciones anuales en todo el planeta, por lo que son consideradas un verdadero azote para la humanidad; dentro de estas, cobra relevancia especial la cardiopatía isquémica por exhibir las mayores tasas de mortalidad universal. Objetivo: Caracterizar a los pacientes fallecidos con diagnóstico de infarto agudo de miocardio. Método: Se realizó un estudio descriptivo transversal con 158 pacientes fallecidos por infarto agudo de miocardio en el Hospital Provincial Universitario Arnaldo Milián Castro de Santa Clara, Villa Clara (Cuba), de 2013 a 2018. Resultados: Predominaron los fallecidos del sexo masculino (83; 52,5%) con edades entre 70 y 79 años (66; 41,8%); 104 fallecidos (65,8%) presentaron al menos cuatro factores de riesgo, con predominio individual de la hipertensión arterial (122; 77,2%), la diabetes mellitus (108; 68,4%) y la dislipidemia (99; 62,7%). La presentación fue típica en ambos sexos (masculino 39 y femenino 55) con localización mayormente anterior extenso y se realizó trombólisis en 51 casos (32,3%), antes de las primeras 12 horas de iniciados los síntomas. La complicación más frecuente fue la disfunción ventricular izquierda (42,4%). No se pudo evaluar la coincidencia diagnóstica en 40 casos, porque no se les practicó necropsia; pero se coincidió totalmente en 86 fallecidos (54,4%) y de forma parcial en 25 (15,8%). Se dejaron de vivir 2774 años y se obtuvo una línea del tiempo descendente. Conclusiones: La mortalidad por infarto agudo de miocardio mostró una ligera tendencia a la disminución de los fallecidos informados por certificado de defunción, con un promedio de 25,2 años de vida potencialmente perdidos.

ABSTRACT Introduction: Cardiovascular diseases account for the largest number of deaths worldwide each year; reason why they are considered a real scourge for humanity. Ischemic cardiomyopathy ranks high among them as it exhibits the highest global mortality rates. Objective: To characterize deceased patients diagnosed with acute myocardial infarction. Method: A cross-sectional descriptive study was carried out with 158 patients who died from acute myocardial infarction in the Hospital Provincial Universitario Arnaldo Milián Castro of Santa Clara, Villa Clara (Cuba), from 2013 to 2018. Results: Males (83; 52.5%) between 70 and 79 years of age (66; 41.8%) predominated. A total of 104 deceased (65.8%) presented at least four risk factors with individual predominance of high blood pressure (122; 77.2%), diabetes mellitus (108; 68.4%) and dyslipidemia (99; 62.7%). The clinical presentation was typical in both sexes (male 39 and female 55), large anterior wall myocardial infarction prevailed, and thrombolysis was performed in 51 cases (32.3%) before the first 12 hours of onset of symptoms. Left ventricular dysfunction was the most frequent complication (42.4%). No necropsy was performed on 40 cases, which did not allow for the assessment of diagnostic coincidence; however, there was a total coincidence in 86 deaths (54,4%) and a partial coincidence in 25 (15,8%). About 2774 years were not lived and a descending time line was attained. Conclusions: Mortality from acute myocardial infarction showed a slight downward trend in the number of deaths reported by death certificate, with an average of 25.2 years of life potentially lost.