Extracardiac PSVT cause?

Introduction: The bound between the upper gastrointestinal pathology and the supraventricular arrhythmia is well known, especially between the gastroesophageal reflux disease and atrial fibrillation / flutter. Possible causes of these associations are: the anatomical border between the esophagus and the left atrium, common vegetative stimulation through the vagus nerve, gastric and systemic inflammation, common comorbidities, but also the arrhythmogenic effect of proton pump inhibitors.1,2
Presentation of the case: 79 years old patient, ethanol consumer, hypertensive and dyslipidemic, is hospitalized for episodes of rapid, regular palpitations, retrosternal pain with constrictive character and fati-gue, that occur and disappear spontaneously. The clini-cal examination does not reveal anything particularly pathological, except for an AV of 150/min, regular; without heart or vascular murmurs. The electrocardiogram shows PSVT aspect, 150/min, ax 60 degrees, where P after QRS and R-P short, where T flattened in DM; then RS, 75/min, T. wavelength flatness. The echocardiogram shows a hyperechogenic image on the left atrium, which in different sections seems to finger-print from the outside the AS wall, having respiratory variation. The barium swallow test shows an important gastric transhiatal hernia. The biological data excluded a current thyroid pathology, an acute coronary syndrome, or an ion imbalance.
Case particularity: T he PSVT cause is probably extracardiac, mechanical, due to large gastric transhiatal hernia. An FDA (U.S. Food and Drug Administration) reported PSVT in 5 patients with gastric transhiatal hernia.
Conclusions: The mechanisms of PSVT triggering can be multiple and are partially elucidated. Upper gastrointestinal pathology should not be excluded as a cause of the onset of supraventricular arrhythmias.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)