Doppler echocardiography, Hiatal hernia, Left heart failure
Acute onset of postprandial left heart failure occurred in a patient with a giant hiatal hernia. This case of heart failure may be attributed to impairment of left ventricular diastolic function, probably caused by direct cardiac compression after meals. After the patient received enteral nutrition (300 ml/3 min) , Doppler echocardiography showed a decrease in peak transmitral flow velocity during the rapid filling phase (E) and unchanged peak transmitral flow velocity during the atrial contraction phase (A). Both E and A decreased when furosemide was administered, and neither left heart failure nor changes in transmitral flow patterns appeared on administration of enteral nutrition. These results suggest that the decrease in E without any change in A on administration of enteral nutrition is not related to preload reduction of the left ventricle, but rather to the impairment of left ventricular function, because preload changed E and A in the same direction.