Gastro-cardiac syndrome (or Roemheld syndrome): symptoms, diagnosis and treatment

By Cristiano Antonino On Feb 22, 2023

Gastro-cardiac syndrome, also known as ‘Roemheld-Techlenburg-Ceconi syndrome’ or ‘gastric fundus hyperdistension syndrome’, was first reported by Ludwing Roemheld (1871-1938) in the late 1900s. It is little described in the literature, but is well known to cardiologists and gastroenterologists

What is gastro-cardiac syndrome?

Gastro-cardiac syndrome is characterised by a complex of functional cardiac disorders triggered by gastric distension.

The cardio-respiratory symptoms are often of such intensity as to alarm the patient who, on suspicion of a real cardiac pathology, immediately turns to the cardiologist or emergency room.

However, once a cardiological liability has been ruled out, the patient is sent to the gastroenterologist for diagnosis and treatment of the underlying digestive pathology.

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What are the symptoms?

The symptoms of Roemheld Syndrome, which generally appear after meals, are diverse and variously associated with each other:

chest pain
difficulty breathing
severe discomfort at the ‘mouth’ of the stomach
gastric distension (often evident in the epigastrium and/or left hypochondrium),
nausea,
asthenia,
feeling of fainting,
difficulty eructating,
sweating,
anxiety,
more or less intense palpitations
difficulty sleeping (especially if you go to sleep a few hours after a meal or lie on your left side).

It is important to emphasise that the symptomatology is not determined by any cardiological pathology, nor can the symptoms impair cardiac function as the syndrome persists.

What are the causes of gastro-cardiac syndrome?

Although the mechanisms by which gastro-cardiac reflexes are triggered are not well understood, it seems that the trigger for gastro-cardiac syndrome is an excess of air in the stomach and in particular in the gastric fundus.

The severely distended stomach can cause the diaphragm, that flat, dome-shaped muscle that separates the chest from the abdomen and the thoracic organs from the abdominal organs, to rise.

The heart, which rests on the diaphragm and is in close contiguity with the gastric fundus, is in turn pushed upwards.

This displacement of the heart muscle causes the activation of ‘reflex’ responses (i.e. independent and involuntary activities) that can lead to the symptoms described above.

Regardless of the mechanical action on the diaphragm and heart, however, it appears that gastric distension alone can activate reflexes (called ‘gastro-cardiac reflexes’) that can lead to the onset of symptomatology.

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To recognise Roemheld syndrome there are no specific tests, but it is a ‘diagnosis of exclusion’

First of all, a specialist cardiological consultation is essential in order to rule out a possible cardiac pathology.

From the gastroenterological point of view, then, any pathologies that may cause or aggravate intestinal meteorism or alter digestive motility must be researched and corrected.

Once organic cardiological and digestive pathologies have been ruled out, the patient should not be considered (as is often the case) a hypochondriac, but a functional syndrome should be suspected and appropriate measures put in place to reduce stomach bloating and promote effective digestive motility, should this be deficient.

Confirmation of gastric distension (sometimes considerable) can be obtained by a direct X-ray of the abdomen at the time of the crisis.

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The prevention of gastro-cardiac syndrome

Since, as already mentioned, the triggering cause seems to be related to gastric distension (the patient often finds immediate relief by belching!) it is necessary to ‘focus’ on the conditions that can lead to ‘stomach bloating’.

It is important, therefore, to eliminate certain ‘bad habits’ about eating behaviour, and then move on to ‘what’ one eats.

Here, in summary, are some general rules to avoid ‘stomach bloating’:

Maintain a healthy weight by taking regular daily exercise.
Do not smoke.
Limit alcohol.
Eat little, several times a day, to avoid overloading the stomach: concentrating all the food in one meal is the equivalent of concentrating a whole day’s work in a few hours!
Eat slowly and chew for a long time to avoid swallowing air that distends the stomach.
One must also remember that the first digestion takes place in the mouth, so eating in a hurry without chewing the food well results in longer gastric work.
Limit very spicy foods and acidic foods such as tomatoes and citrus fruits.
Never eat until you feel completely full.
Try to eat ‘calmly’ and if you are at work, avoid eating quickly and standing up: eat your meal calmly, if possible sitting down, giving yourself at least 20-30 minutes to relax before resuming work.
Do not wear clothes that are too tight, especially at the table.
Moderate the use of drinks containing caffeine (such as chocolate, coffee, tea).
Take a walk after meals and avoid ‘lying down’ immediately.

On the basis of the patient’s medical history, the gastroenterologist will indicate specific corrective measures to the patient and, if necessary, prescribe targeted pharmacological treatment (prokinetics, antimeteorics, etc.).

If this approach proves insufficient or ineffective, the patient’s psychological state must then be assessed and, if necessary, psychotherapeutic support recommended.

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