Roemheld Syndrome Treatment- Cardiology, Gastroenterology
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Roemheld syndrome (RS), also known as Roemheld-Techlenburg-Ceconi-Syndrome or gastric-cardia, is a complex of gastrocardiac symptoms first described by Ludwig von Roemheld (1871–1938). Roemheld syndrome (or gastric-cardia syndrome) is a complex of gastro-cardiac symptoms where the gastrointestinal tract (GI) triggers various cardiac symptoms such as shortness of breath, nausea, sweating, palpitations, skipped or extra beats etc.
The Roemheld syndrome arises due to the complex relationship between the gut and the nervous system, along with the nervous system’s association with the heart.
Gastroenterologists and cardiologists are the medical specialists who will be involved in treatment of Roemheld Syndrome.
- Tachycardia (Increased Heart Rate)
- Arrhythmia (Irregular Heart Beat)
- Ringing sound in ears
- Trapped stomach and intestinal gas
Connection of Vagus Nerve
Research conducted in the late 1920s to 1940s showed that the vagus nerve is a vital link to the syndrome since it is the link between the brain, heart, lungs and GI tract. The vagus nerve also conveys sensory details regarding the state of the bodys organs to the brain.
Treatment of the primary gastroenterological distress is the first concern, mitigation of gastric symptoms will also alleviate cardiac distress.
- Anticholinergics, magnesium, or sodium (to raise blood pressure) supplements
- Anticonvulsants have eliminated all symptoms in some RS sufferers; Lorazepam, Oxcarbazepine increase GI motility, reduce vagus "noise" (sodium channel blocking believed to contribute to positive effects)
- Alpha blockers may increase gi motility if that is an issue, also 5 mg to 10 mg amitriptyline if motility is an issue that can't be solved by other methods
- Antigas - simethicone, beano, omnimax reduces epigastric pressure
- Antacids - nexium, tums, Pepcid AC, rolaids, etc. reduces acid reflux in the case of hiatal hernia or other esophageal type RS.
- Beta blockers - reduces contractility and automaticity of the heart which reduces irregular rhythms but also lowers blood pressure when symptoms occur, and further reduces perfusion ex: Atenolol, this will control disarrhythmia, but can precipitate Prinzmetal Angina and Heart block substantially.
There is significant scope of misdiagnosis of RS. Diagnosis of RS usually starts with a cardiac workup, as the gastric symptoms may go unnoticed, the cardiac symptoms are scary and can be quite severe. After an EKG, Holter monitor, tilt test, cardiac MRI, cardiac CT, heart catheterization, EP study, echo-cardiogram, and extensive blood work, and possibly a sleep study, a cardiologist may rule out a heart condition.
Often a psych workup may ensue as a conversion disorder may be suspected in the absence of heart disease, or structural heart abnormalities.
Diagnosis is often made based on symptoms in the absence of heart abnormalities. A gastroenterologist will perform a colonoscopy, endoscopy, and ultrasound to locate or eliminate problems in the abdomen.
Determining the cause of Roemheld syndrome is still not an exact science. If you have an ultrasound or sleep study, ensure that you know how to reproduce the symptoms, as it is difficult to detect any abnormalities when symptoms have subsided.
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