Copyright@ Abuzer Coskun | Biomed J Sci & Tech Res | BJSTR. MS.ID.006975. 35070 Case Report ISSN: 2574 -1241 DOI: 10.26717/BJSTR.2022.43.006975 A Rare Cause of Syncope: Hiatal Hernia Adem Melekoğlu 1 , Ertuğrul Altinbilek 1 and Abuzer Coskun 2 * 1 Health Sciences University, Sisli Hamidiye Training and Research Hospital, Emergency Medicine Clinic, Turkey 2 Health Sciences University, Bagcilar Training and Research Hospital, Department of Emergency Medicine, Turkey *Corresponding author: Abuzer Coskun, SBU Istanbul Bagcilar Training and Research Hospital, Emergency Medicine Clinic, Central Neighborhood, Dr. Sadık Ahmet Street, Istanbul, Turkey ARTICLE INFO ABSTRACT Received: May 05, 2022 Published: May 18, 2022 Citation: Adem Melekoğlu, Ertuğrul Al- tinbilek, Abuzer Coskun. A Rare Cause of Syncope: Hiatal Hernia. Biomed J Sci & Tech Res 43(5)-2022. BJSTR. MS.ID.006975. Syncope is a temporary loss of consciousness due to transient global cerebral hypoperfusion, characterized by rapid onset, short duration, and spontaneous and complete recovery. Syncope is divided into three groups: reflex, syncope due to orthostatic hypotension, and cardiac syncope [1]. Reflex syncope is the most common cause of syncope both in the general practitioner setting and in the emergency room. It is the most common cause of syncope in the young, whereas in older adults there is often more than one cause and the history may be unreliable [2]. Hiatal hernia is a gastrointestinal disease, the frequency of which increases with advancing age. Its main symptoms are epigastric-substernal pain, heartburn, reflux, dysphagia [3]. In some reports, chest tightness, arrhythmia, and syncope due to heart failure were mentioned in relation to the size of the hernia [4]. Although vasovagal reflex and cardiac tamponade caused by increased intratoacic pressure due to intestinal hernia are rarely seen, postprandial syncope may be seen in patients [5,6] In this article, we planned to present a case who developed postprandial syncope and was brought to the emergency room for this reason. Case Presentation An 84-year-old female patient had a recent complaint of chest pain, especially after meals. After the syncope that developed after the evening meal, the rescuer was brought to the emergency room by his healthcare team. Pre-hospital vitals of the patient blood pressure arterial: 120/70mmHg, pulse: 80/min, respiratory rate: 16/min, fever: 36.7 C°, oxygen saturation (SO 2 ): 98 were measured. When the patient with a known history of coronary artery disease, hypertension, diabetes mellitus was brought to the emergency room, he was conscious, cooperative and oriented. Electrocardiography (ECG) was observed as normal sinus rhythm. The patient was monitored in the emergency department, and his vitals were found to be stable. When the patient, whose hematological tests were normal, was placed in the supine position to take the control ECG, it was observed that the patient had sinus bradycardia and a short- term loss of consciousness. On the monitor, the patient’s heart rate dropped to 20/min. When the patient was quickly put into a sitting position, it was observed that his consciousness and heart rhythm returned to normal. However, some vomiting occurred after the gag reflex in the patient. Free air was observed in the intrathoracic cardiac area in the anteroposterior chest X-ray of the patient (Figure 1). To confirm the diagnosis, cardiopulmonary Computed Tomography (CT) angiography image of the patient was taken. CT image of the patient revealed a large hiatal hernia causing compression on the left atrium (Figure 2). A nasogastric tube was inserted immediately and the contents of the patient’s hernia were evacuated. The patient was relieved after gastric drainage, and it was observed that his complaints did not develop even in the supine position. The patient was admitted to the general surgery service for surgical treatment.