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March 2, 1963

Coronary Disease and Hiatal HerniaAn Example in Support of the Existence of a Viscerocardiac Reflex

JAMA. 1963;183(9):788-790. doi:10.1001/jama.1963.63700090030020

IT IS WELL DOCUMENTED that coronary insufficiency and hiatal hernia may produce identical chest pain.1-3 However, it is less generally appreciated that when both conditions occur simultaneously there may be actual interplay between the esophageal disease and the coronary-artery disease.

The purpose of this report is to describe a patient who had coronary insufficiency and a hiatal hernia; whose pain and classical ST-T changes in the electrocardiogram of myocardial ischemia were regularly induced by (1) exercise in the fasting state and (2) distention of the hernia with barium or with food with the patient in the recumbent position. Surgical correction of the hernia abolished both the pain and the electrocardiographic changes produced by the distention of the hernia with barium and food but did not affect the classical response to the exercise test.

These observations offer evidence suggestive of the existence of a true viscerocardiac reflex.

Report of a