Thursday, December 11, 2014

Palpitations after Dinner (Non-Cardiac Cause of Palpitation)

A 76-year-old woman with rheumatoid arthritis, diabetes mellitus, and hypertension presented with a 1-month history of palpitations that occurred only after she had eaten dinner. The sensation was felt at the center of the chest and lasted for 10 to 15 minutes after the meal. An electrocardiogram was unremarkable. A chest radiograph (Panel A) showed a mediastinal shadow (white arrowheads) lateral to the left heart border (black arrowheads). Computed tomography of the chest revealed a left diaphragmatic hernia (Panel B), with the stomach positioned in the thorax (Panel C, coronal view), abutting the left ventricle (Panel D, axial view, arrowheads). The stomach was visibly twisted, a finding consistent with a gastric volvulus. Gastric endoscopy revealed a volvulus, with twisting of the mucosa. After surgical repair of the hernia and volvulus, the palpitations resolved, and at follow-up more than 1 year after surgery, the patient remained free of symptoms.

Kazutaka Kurokohchi, M.D., Ph.D., and Osamu Imataki, M.D.
N Engl J Med 2014; 371:2320

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