{"id":1202,"date":"2026-06-13T14:08:30","date_gmt":"2026-06-13T14:08:30","guid":{"rendered":"https:\/\/roemheld.org\/?p=1202"},"modified":"2026-06-13T14:13:06","modified_gmt":"2026-06-13T14:13:06","slug":"case-report-heartburn-associated-with-sinus-pauses-in-gastrocardiac-syndrome","status":"publish","type":"post","link":"https:\/\/roemheld.org\/de\/case-report-heartburn-associated-with-sinus-pauses-in-gastrocardiac-syndrome\/","title":{"rendered":"Case Report: Heartburn Associated with Sinus Pauses in Gastrocardiac Syndrome"},"content":{"rendered":"<p class=\"wp-block-paragraph\"><strong>In 2024, the following article was published in the Chest Journal<br><br><\/strong><\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p class=\"wp-block-paragraph\"><br><code>KHRESHI S, KHRAISHI R, PAK D ...<strong>HEARTBURN TO HEART SKIPS: GASTRIC OR CARDIAC?<\/strong>CHEST, 166, A815-A816<br><a href=\"https:\/\/journal.chestnet.org\/article\/S0012-3692%25252824%25252901351-5\/fulltext\">https:\/\/journal.chestnet.org\/article\/S0012-3692%25252824%25252901351-5\/fulltext<\/a><\/code><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Summary<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This case report describes a 53-year-old man with a history of gastroesophageal reflux disease (GERD), type 2 diabetes mellitus, and gout who presented to hospital with flank pain.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">During admission, telemetry monitoring unexpectedly revealed multiple episodes of significant bradycardia and sinus pauses. Heart rates fell as low as 43 beats per minute, while some sinus pauses lasted between 2.5 and 7.4 seconds.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Although these findings initially raised concern for a serious cardiac condition, the patient remained hemodynamically stable throughout the episodes. Physicians noted a striking pattern: every episode of bradycardia or sinus pause was accompanied by symptoms of epigastric burning and heartburn.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">An extensive cardiac evaluation was performed. Blood tests, including electrolytes and troponin levels, were normal. Echocardiography demonstrated no wall motion abnormalities or other significant structural heart disease. Following cardiology review, the physicians concluded that the presentation was most consistent with Gastrocardiac Syndrome, also known as Roemheld Syndrome.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The patient\u2019s proton pump inhibitor (PPI) therapy was increased, and he was discharged with cardiology follow-up.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">After discharge, the patient continued to monitor his heart rate using a personal monitoring device. He reported ongoing episodes of nonsustained sinus bradycardia that continued to occur at the same time as his gastric symptoms.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Why This Case Is Important<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most modern reports of Roemheld Syndrome focus on palpitations, premature beats, tachycardia, or atrial fibrillation.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This case is unusual because the primary cardiac manifestation was marked bradycardia accompanied by prolonged sinus pauses. Some pauses lasted more than seven seconds, making this one of the more dramatic examples of slow heart rhythm disturbances reported in association with gastrocardiac symptoms.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The report is also notable because physicians observed a consistent temporal relationship between heartburn and cardiac rhythm disturbances. According to the authors, every episode of sinus pauses or bradycardia occurred simultaneously with epigastric burning.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Proposed Mechanisms<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The authors discuss several possible explanations for Gastrocardiac Syndrome, including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Increased vagal nerve activity<\/li>\n\n\n\n<li>Gastric inflammation<\/li>\n\n\n\n<li>Gastroesophageal reflux disease (GERD)<\/li>\n\n\n\n<li>Chronic inflammatory processes<\/li>\n\n\n\n<li>Hiatal hernia and related gastrointestinal disorders<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">They note that Gastrocardiac Syndrome remains a diagnosis of exclusion and should only be considered after common cardiac causes have been ruled out.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Editor\u2019s Note<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This report is particularly interesting because of the close synchronization between gastric symptoms and cardiac rhythm disturbances.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Unlike some published case reports in which treatment of a gastrointestinal condition resulted in complete resolution of cardiac symptoms, that was not the case here. The patient continued to experience intermittent episodes of sinus bradycardia after discharge. However, he also reported that these episodes continued to occur at the same time as his gastric symptoms.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For that reason, the strongest aspect of this report is not the treatment outcome, but the temporal relationship observed by both the treating physicians and the patient himself. According to the authors, every episode of significant bradycardia or sinus pause was accompanied by epigastric burning.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">While the exact mechanism remains uncertain, this report adds to a growing body of literature suggesting that disturbances within the gastrointestinal tract may be associated with a surprisingly broad range of cardiac rhythm abnormalities. In addition to palpitations, premature beats, and atrial fibrillation, this case highlights the possibility that Gastrocardiac Syndrome may also present with significant bradycardia and sinus pauses in certain individuals.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">As with all case reports, conclusions should be drawn cautiously. Nevertheless, the repeated association between heartburn and sinus pauses described in this patient is difficult to ignore and warrants further investigation.<\/p>","protected":false},"excerpt":{"rendered":"<p>In 2024, the following article was published in the Chest Journal KHRESHI S, KHRAISHI R, PAK D &#8230;HEARTBURN TO HEART&#8230;<\/p>","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_kadence_starter_templates_imported_post":false,"_kad_post_transparent":"","_kad_post_title":"","_kad_post_layout":"","_kad_post_sidebar_id":"","_kad_post_content_style":"","_kad_post_vertical_padding":"","_kad_post_feature":"","_kad_post_feature_position":"","_kad_post_header":false,"_kad_post_footer":false,"_kad_post_classname":"","footnotes":""},"categories":[25,19],"tags":[50,21,49,29,15,16,52,41,37],"class_list":["post-1202","post","type-post","status-publish","format-standard","hentry","category-case-reports","category-medical-studies","tag-arrhythmias","tag-gastro-cardiac-syndrome","tag-gastrointestinal-cardiac-symptoms","tag-ppi","tag-roemheld","tag-roemheld-syndrome","tag-sinus-pauses","tag-stomach","tag-surgery"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.1 - 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