Roemheld Syndrome

The Roemheld Syndrome is a name for heart problems caused by gas accumulation in the gastrointestinal tract. Symptoms such as palpitations or shortness of breath occur.

What is Roemheld Syndrome?

The Roemheld Syndrome was first described at the beginning of the 20th century by the internist Ludwig von Roemheld from Gundelsheim.

In Roemheld syndrome, gastrointestinal complaints occur. These are caused by the accumulation of gas in the intestines and stomach. In severe cases, Roemheld syndrome can be confused with angina pectoris or with a heart attack.

causes

Roemheld syndrome is caused by gases in the gastrointestinal tract that push the diaphragm upwards. This leads to a reduction in the size of the chest. The organs of the chest have less space and are displaced or narrowed. There are again several causes for the increased gas formation. Lush meals can lead to gas formation, especially in combination with poor digestion.

Functional disorders of the gastrointestinal tract can also be the cause of Roemheld syndrome. Functional gastrointestinal complaints are signs or symptoms that occur for no apparent organic cause. However, inflammation in the gastrointestinal area can also lead to increased gas formation.Food intolerance is another common reason for gases in the gastrointestinal tract. The most common are lactose or fructose intolerances. The cause of these intolerances is usually an enzyme deficiency.

Roemheld syndrome can also occur with a disorder of the gallbladder function. If the bile juices do not flow properly, ingested dietary fat cannot be digested in the intestine. The consequences are putrefaction and fermentation processes. A rather rare reason for Roemheld syndrome is the so-called hiatal hernia. This is also known as a diaphragmatic hernia, because part of the stomach enters the chest cavity through the diaphragm. Roemheld syndrome can also occur after taking acid blockers with sodium bicarbonate.

Symptoms, ailments & signs

The accumulation of air in the stomach and intestines pushes the diaphragm upwards. There it exerts direct or indirect pressure on the heart. The result is various heart problems. Heart palpitations occur, possibly even extrasystoles. In some cases, sinus bradycardia also occurs. Sinus bradycardia is a heart rate that is less than 60 beats per minute.

It starts from the sinus node, a pacemaker in the heart. The symptoms of Roemheld syndrome are similar to angina pectoris and even heart attack. Those affected suffer from attacks of chest pain. These can last seconds, minutes and rarely hours. Patients often describe the pain as a burning sensation. It is not uncommon for the symptoms to be confused with heartburn.

The pain can radiate to the sides of the chest, shoulders, upper arms, upper abdomen, neck and lower jaw. In addition, hot flashes and dizziness occur in Roemheld syndrome. In severe cases, the affected patients may even pass out.

Diagnosis & course of disease

When diagnosing Roemheld syndrome, it is primarily important to rule out organic heart diseases as the cause of the symptoms. For this, an EKG is first made. The EKG records the electrical activity of the heart muscle fibers. A long-term ECG is usually also performed. The cardiac current curve is recorded over a period of 24 hours.

If the ECG does not provide any information, further heart examinations are carried out. Cardiac computed tomography can be used to display the coronary vessels in high resolution. Any constrictions or thromboses can be detected in this way. However, echocardiography and left heart catheter examination allow a better assessment of the vascular condition. A cardiac MRI may also be performed on the affected patient.

Complications

Because of the Roemheld syndrome, those affected suffer from complaints in the stomach, intestines and also the heart. In the worst case, Roemheld syndrome can also lead to death if no treatment is initiated. Those affected suffer from strong pressure in the abdomen, so that the heart is also under pressure.

This can cause the heart rate to drop significantly, leading to dizziness or a fainting attack. In many cases, those affected depend on a pacemaker in order to survive. There is severe chest pain, and people experience a burning sensation in the throat or heart area.

The arms or shoulders can also be affected by the pain as it spreads. The quality of life of the person affected is significantly reduced. Treatment for Roemheld syndrome is usually always based on the root cause. This can take place with the help of antibiotics and fight inflammation. There are no complications. Drinking tea can also significantly reduce the gas in the stomach. Successful treatment does not affect the patient's life expectancy.

When should you go to the doctor?

After a confirmed diagnosis, Roemheld syndrome basically does not require a further visit to the doctor. Nevertheless, there are reasons that may make it necessary to go to a doctor. This applies to the cases in which the gas accumulations that lead to the heart sensations cannot be controlled by the patient. The family doctor or internist, but also dietitians as competent contacts, can help here. Exercise therapy, which can significantly reduce the accumulation of gas in the intestine, is also often useful.

Another reason to see a doctor for Roemheld syndrome is a change in the heart's actions that can be caused by the gas in the intestines and stomach. If the heart palpitations or palpitations occur to a degree that was previously unknown, the doctor, possibly also a cardiologist, should be consulted. He will clarify whether the Roemheld syndrome is not masking a previously undiscovered heart disease.

In many cases, Roemheld syndrome and its symptoms also disturb the sleep of those affected. Often fears are added because those affected consider the heart's actions, which are basically harmless, to be threatening. The family doctor can help with the conversation and, in cases in which the fear seems uncontrollable, refer to a psychologist. Relaxation methods such as progressive muscle relaxation or yoga can also help to reduce anxiety and noticeably reduce insomnia.

Therapy & Treatment

Therapy depends on the cause. If you are lactose intolerant, milk and dairy products such as yogurt, cheese or quark should be avoided. Depending on the severity of the intolerance, patients must follow a lactose-free or a lactose-free diet. The missing enzyme lactase can also be supplied as a tablet. This means that patients can tolerate some foods containing lactose again.

The treatment of fructose intolerance consists of a sorbitol-free and a low-fructose diet. If the Roemheld syndrome is based on gastroenteritis, it may have to be treated with antibiotics, depending on the pathogen. Pronounced diaphragmatic hernias must be surgically removed. In addition to treating the root cause, anti-carminative drugs can be used in Roemheld's syndrome.

Anticarminatives are remedies for flatulence. Herbal medicinal drugs with essential oils have a carminative effect. Carminative plants include anise, fennel, caraway, peppermint, chamomile, and coriander. These oils have a relaxing effect on the smooth intestinal muscles and have an antimicrobial effect. The blood flow to the intestinal mucosa is also increased. These effects lead to a reduced formation of fermentation gases.

prevention

Food and drinks that cause gas should be avoided to prevent Roemheld syndrome. Legumes, cabbage, onions, nuts and some types of fruit are just as gas-inducing as starch, frozen foods and artificial sweeteners. Carbon dioxide in beverages can also cause gas to accumulate in the gastrointestinal tract. Vegetables should only be consumed raw in exceptional cases.

It is advisable to steam the vegetables briefly before consumption. This enables the enzymes in the digestive tract to break down the vegetables better. There are fewer fermentation and putrefaction processes. Recent studies show that regular intake of probiotics can prevent gastrointestinal gas formation in the intestines. The bacterial species Lactobacillus in particular seems to play a role here.

A cure with apple cider vinegar is also recommended. Simply drink a teaspoon of apple cider vinegar with half a glass of water three times a day on an empty stomach. The cure should be carried out over three weeks. To prevent Roemheld syndrome, large meals should also be avoided. Five to six small servings that are eaten throughout the day are better than a few large meals.

Aftercare

Roemheld syndrome is a symptom that is particularly accessible for follow-up care and which absolutely requires the cooperation of the patient. This is due to the fact that the Roemheld syndrome is mostly closely related to the behavior of the patient. In order to avoid the typical symptoms in the long term, changes in behavior are often necessary, which should also be maintained in the context of aftercare.

This includes avoiding large meals before bed. The same applies to fatty or flatulent foods, as these can also trigger Roemheld syndrome. Sleeping with your torso slightly raised can prevent or at least relieve the symptoms. Drinking sufficient amounts is also important in the follow-up care for Roemheld syndrome. Carbon dioxide can aggravate the symptoms. That is why still water and herbal teas are ideal for aftercare for Roemheld syndrome. Alcohol should be avoided as well as nicotine.

Roemheld syndrome is often associated with obesity. It is therefore advisable for these patients to consistently include weight reduction in the follow-up care. Movement is particularly suitable for this, which can be integrated into an individual aftercare concept in coordination with sports teachers or fitness trainers. Dietitians or nutritionists will help with the right diet, which consists of lots of fruits and vegetables and is low in fat.

You can do that yourself

The Roemheld Snydrom is particularly accessible for self-help in everyday life, it even makes the active cooperation of patients in coping with this appearance indispensable. Because heart sensations caused by a full stomach require that the abundance of the stomach contents is deliberately kept to a comfortable level. That means not to eat so much until you feel bloated, but to stop beforehand.

Chopping up food through consistent chewing and drinking enough water also play an important role in this context. Flatulent foods such as legumes are also better to reduce. The same applies to fat and indigestible food that is heavy in the stomach. The food should be consumed consciously, especially at dinner. Heavy food before going to bed can make Roemheld syndrome worse, as the stomach contents are pushed up in the supine position.

Exercise is also an important factor when it comes to coping with Roemheld Syndrome in everyday life. Because the digestive tract reacts positively to movement and can be activated as a result. A walk after dinner is often very helpful here. In acute Roemheld syndrome, light movement is also better than resting in the supine position. A gentle massage in the abdominal area can also speed up digestion a little and soon alleviate the symptoms.