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conferenceseries
.com
Volume 8
Journal of Gastrointestinal & Digestive System
GI Diseases 2018
July 11-12, 2018
July 11-12, 2018 Sydney, Australia
15
th
International Conference on
Digestive Disorders and Gastroenterology
Large diaphragmatic hernia induced reversible heart failure
Ramon Docobo
St. Matthew's University, USA
D
iaphragmatic hernias are typically congenital and happen during the fetal development stages. Diaphragmatic hernias can
be classified into two types: Bochdalek and Morgagni. Bochdalek type is seen in this case and is defined where the stomach
and small intestine contents are found in the thoracic cavity. Below we see a rare case in which a diaphragmatic hernia leads to
a reversible cause of heart failure. This is a 50 year female with PMH of hypertension and diabetes presenting with worsening
shortness of breath, on and off for the last three weeks. Patient denied any fever, chills, chest pain or wheezing. Shortness of
breath with rest and exertion is associated. Physical exam showed mild JVD elevation and bilateral lower extremity trace edema.
On admission, CXR showed right middle lobe pneumonia and large left sided diaphragmatic hernia. CT chest then confirmed
the above and showed the diaphragmatic hernia penetrating posteriorly into the thoracic cavity. ECHO showed both grade three
diastolic dysfunctions without concentric hypertrophy and reduced ejection fraction of 40%. BNP level was 748. Hemoglobin
A1c was 6.8, on Metformin and Glipizide. Because of ECHO results, patient underwent a Lexiscan stress test in which it showed
a high risk of CAD with possible inferior ischemia. Patient then underwent cardiac catheterization which confirmed an ejection
fraction of 40% and only mild stenosis of 25% of the LAD. Patient started on Carvedilol and Lasix in the addition of Lisinopril
that she was already on for hypertension. Patient was then referred to surgery for correction of the diaphragmatic hernia. Repeat
ECHO three months post operatively showed that ejection fraction improved to 50% and diastolic dysfunction improved as
well now only being Grade 1 diastolic dysfunction. Diaphragmatic hernia has been associated with respiratory complications
but typically not cardiac. In this case, the patient was found to have both systolic and diastolic dysfunction which resolved with
correction of the diaphragmatic hernia. Initially patient was thought to have an ischemic cardiomyopathy, but once cardiac
catheterization was unremarkable this pointed more towards the diaphragmatic hernia. Additional concern was patient’s history
of diabetes with this potentially contributing to heart failure. Given that patient’s hemoglobin A1c was 6.8, again this pointed
towards the diaphragmatic hernia contributing to these findings. Given the increase in intra-thoracic pressure in the setting
of the large diaphragmatic hernia, diastolic function is affected. Left ventricular filling is compromised during this stage of the
cardiac cycle. Hypertension was of concern as well, but again, given the fact that the ECHO did not demonstrate any concentric
hypertrophy and the reversal after corrected surgery, we can conclude that this was secondary to the diaphragmatic hernia.
r.a.docobo@gmail.comJ Gastrointest Dig Syst 2018, Volume 8
DOI: 10.4172/2161-069X-C2-068