Roemheld syndrome

Originally termed "Roemheld-Techlenburg-Ceconi-Syndrome", and now known as Roemheld Syndrome, RS, or gastric-cardia it is used to characterize a complex of gastrocardiac symptoms, first described by Ludwig Roemheld (1871-1938):

A syndrome where maladies in the GI tract or abdomen trigger/cause cardiac symptoms. There is rarely a traceable cardiac source to the symptoms which may lead to a lengthy period of mis diagnosis.

Psychophysiology

Characterized by pressure in the epigastric and left hypochondriac region it is believed this leads to elevation of the diaphragm, and secondary displacement of the heart causing stimulation of the vagus nerve and a variety of cardiac symptoms e.g. sinus bradycardia, arrhythmia, heart block, etc.

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 irradiation to the left shoulder, dyspnea, sweating, up to angina pectoris -like attacks with extrasystoles, drop of blood pressure, and tachycardia (high heart beat) or sinus bradycardia (heart beat below 60). 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.

If the heart rate drops too low for too long, catecholamines are released by the brain 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.

History

Ludwig Roemheld characterized this particular syndrome shortly before his death; one of his research topics around this time was the effects of calorie intake on the heart. In Elsevier, there is no current research or publishing under the name Roemheld Syndrome, and as a result many cases go undiagnosed. German publishing on the subject remains untranslated as of 2009.

Symptoms

(Symptoms are periodic, and occur only during an "episode" usually after eating)

• Sinus Bradycardia
• Difficulty inhaling
• Angina pectoris
• Left ventricular discomfort
• 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 laying on the left side)
• Extrasystoles
• Hot Flashes

Common Causes

As gas is the usual trigger, eating foods that a person is intolerant to can make symptoms more severe.

• Excessive gas in the transverse colon caused by:
  • Lactose intolerance
  • Alpha-galactose intolerance
  • Fructose intolerance
• abnormal Gall-Bladder function and/or blood flow
• Sphincter of Oddi dysfunction
• Hiatal Hernia
• Cardiac Bridgeing (Coronary occluding reflexes triggered by coronary reflexes)
• Enteric Disease
• Aneructonia 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

Diagnosis of RS usually starts with a cardiac workup, as the gastric symptoms may go unnoticed, the cardiac symptoms are scary and can be quite severe. After a EKG, halter monitor, tilt test, cardiac MRI, cardiac CT, Heart catheterization, EP study, echo-cardiogram, and extensive blood work, and possible a sleep study, a cardiologist may rule out a heart condition.

Oftentimes a psych workup may ensue as a conversion disorder may be suspected in the absence of heart disease, or structural heart abnormalities.

Diagnosis is often made based on symptoms in the absence of heart abnormalities. A gastroenterologist will perform a colonoscopy, endoscopy, and ultrasound to locate or eliminate problems in the abdomen.

Determining the cause of Roemheld syndrome is still not an exact science. If you have an ultrasound or sleep study, ensure that you know how to reproduce the symptoms, as it is difficult to detect any abnormalities when symptoms have subsided.

Therapy

Treatment of the primary gastro interlogical distress is the first concern, mitigation of gastric symptoms will also alleviate cardiac distress.

• anticholinergics treats the vagus nerve
• Alpha blockers may increase gi motility if that is an issue, also 5 mg to 10 mg amitriptyline if motility is an issue that can't be solved by other methods
• antigas - simethicone, beano, omnimax reduces epigastric pressure
• antacids - nexium, tums, Pepcid AC, rolaids, etc. reduces acid reflux in the case of hiatal hernia or other

vagusectomy

• beta blockers - reduces contractility and automaticity of the heart which reduces irregular rhythms but also lowers blood pressure when symptoms occur, and further reduces perfusion.

See also

Swallowing Syncope A kissing cousin of Roemheld Syndrome

References

de:Roemheld-Syndrom uk:Гастрокардіальний синдром