Hiatus hernia (HH) is a frequent condition and is asymptomatic most of the time. Common symptoms can include epigastric pain, postprandial fullness, and nausea. We report a case of postprandial acute right and left heart failure caused by an intrathoracic stomach in a previously asymptomatic woman. Clinical manifestations included acute pulmonary edema and severe hypotension after administration of vasodilators for treatment of acute left heart failure. Chest computed tomography images showed a pre- and afterload compromise caused by a large compressive HH with massive gastric distension. To the best of our knowledge, ours is the first report of both acute right and left heart failure due to an HH. The prompt placement of a nasogastric tube was lifesaving. We believe that the diagnosis of HH ought to be taken into consideration by emergency physicians and included in the differential diagnosis for acute postprandial heart failure.
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