Roemheld syndrome

Roemheld syndrome (RS), or gastrocardiac syndrome,[1][2][3][4] or gastric cardiac syndrome[5] or Roemheld-Techlenburg-Ceconi-Syndrome[6] or gastric-cardia,[6] was a medical syndrome first coined by Ludwig von Roemheld (1871–1938) describing a cluster of cardiovascular symptoms stimulated by gastrointestinal changes. Although it is currently considered an obsolete medical diagnosis, recent studies have described similar clinical presentations and highlighted potential underlying mechanisms.[7] [8] [9].

Roemheld syndrome
Other namesRoemheld-Techlenburg-Ceconi-Syndrome or Gastric-cardia
SpecialtyGastroenterology/cardiology

Symptoms

Symptoms can be as follows.[10][11] They are periodic, and occur only during an "episode", usually after eating.

Mechanical

Mechanically induced RS is characterized by pressure in the epigastric and left hypochondriac region. Often the pressure is in the fundus of the stomach, esophagus or distention of the bowel. It is believed this leads to elevation of the diaphragm, and secondary displacement of the heart. This reduces the heart's ability to fill and increases the contractility of the heart to maintain homeostasis.

Neurological

The cranium dysfunction mechanical changes in the gut can compress the vagus nerve at any number of locations along the vagus, slowing the heart. As the heart slows, autonomic reflexes are triggered to increase blood pressure and heart rate.

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 radiation 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, missing coronary, and atherosclerosis.

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

Causes

Diagnosis

There is significant scope of misdiagnosis of RS. 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 an EKG, Holter monitor, tilt test, cardiac MRI, cardiac CT, heart catheterization, EP study, echo-cardiogram, and extensive blood work, and possibly a sleep study, a cardiologist may rule out a heart condition.

Often 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.

Treatment

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

Epidemology

Roemheld syndrome is characterized strictly by abdominal maladies triggering reflexes in the heart. There are a number of pathways through which cardiac reflexes can occur: hormones, mechanical, neurological and immunological.

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.

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See also
  • Swallowing syncope

References
  1. Pelner, Louis (1944). The Diet Therapy of Disease: A Handbook of Practical Nutrition. Personal diet service. ROEMHELD, L.; Treatment of Gastrocardiac Syndrome
  2. Hempen, Carl-Hermann; Fischer (MD.), Toni (2009-01-01). A Materia Medica for Chinese Medicine: Plants, Minerals, and Animal Products. Elsevier Health Sciences. ISBN 9780443100949.
  3. Saeed, Mohammad; Bhandohal, Janpreet Singh; Visco, Ferdinand; Pekler, Gerald; Mushiyev, Savi (2018-08-01). "Gastrocardiac syndrome: A forgotten entity". The American Journal of Emergency Medicine. 36 (8): 1525.e5–1525.e7. doi:10.1016/j.ajem.2018.05.002. ISSN 0735-6757. PMID 29764738.
  4. "Current Medical Literature volume 97 number 12" (PDF). p882 This complex of symptoms, for which the term "gastrocardiac syndrome" (gastric cardiopathy
  5. "Clinical experience of treating 82 cases of gastric cardiac syndrome with traditional Chinese medicine".
  6. Modestus, Jamey Franciscus (October 2011). Roemheld Syndrome. Strupress. ISBN 9786137960998.
  7. Saeeda, M; Janpreet, SB; Visco, F; Pekler, G; Mushiyev, S (May 2018). "Gastrocardiac syndrome: a forgotten entity". The American Journal of Emergency Medicine. 36 (8): 1525.e5-1525.e7. doi:10.1016/j.ajem.2018.05.00. PMID 29764738.
  8. Linz, Dominik; Hohl, Mathias; Vollmar, J; Ukena, C; Mahfoud, F; Böhm, M (January 2017). "Atrial fibrillation and gastroesophageal reflux disease: the cardiogastric interaction". EP Europace. 19 (1): 16–20. doi:10.1093/europace/euw092. PMID 27247004.
  9. Ehlers, A; Mayou, RA; Sprigings, DC; Birkhead, J (1999). "Psychological and perceptual factors associated with arrhythmias and benign palpitations". Psychosomatic Medicine. 62 (5): 693–702. doi:10.1097/00006842-200009000-00014. PMID 11020100.
  10. Lok, NS; Lau, CP (June 1996). "Prevalence of palpitations, cardiac arrhythmias and their associated risk factors in ambulant elderly". International Journal of Cardiology. 54 (3): 231–6. doi:10.1016/0167-5273(96)02601-0. PMID 8818746.
  11. Sharma, Shekhar. "Roemheld Syndrome - Gastric Cardia". roemheld-syndrome.com. Retrieved 28 March 2017.
  12. Roman, C; Bruley des Varannes, S; Muresan, L; Picos, A; Dumitrascu, DL (28 July 2014). "Atrial fibrillation in patients with gastroesophageal reflux disease: a comprehensive review". World Journal of Gastroenterology. 20 (28): 9592–9. doi:10.3748/wjg.v20.i28.9592. PMC 4110594. PMID 25071357.
  13. Dittler, Edgar Leon; McGavack, Thomas H. (September 1938). "Pancreatic necrosis associated with auricular fibrillation and flutter". American Heart Journal. 16 (3): 354–362. doi:10.1016/S0002-8703(38)90615-5.
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