Medicine:Roemheld syndrome

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Roemheld syndrome
Other namesRoemheld–Techlenburg–Ceconi syndrome
Gastrocardiac Syndrome

Roemheld syndrome (RS), or gastrocardiac syndrome,[1][2][3][4][5] or gastric cardiac syndrome[6] or Roemheld–Techlenburg–Ceconi syndrome[7] or gastric-cardia,[7] was a medical syndrome first coined by Ludwig von Roemheld (1871–1938) describing a cluster of cardiovascular symptoms stimulated by gastrointestinal changes. Although it is currently considered an obsolete medical diagnosis, recent studies have described similar clinical presentations and highlighted potential underlying mechanisms.[3][8][9][5]

Symptoms and signs

Symptoms can be as follows.[10][11] They are periodic, and occur only during an "episode", usually after eating.


Mechanically induced Roemheld syndrome is characterized by pressure in the epigastric and left hypochondriac region. Often the pressure is in the fundus of the stomach, esophagus or distention of the bowel. It is believed this leads to elevation of the diaphragm, and secondary displacement of the heart. This reduces the heart's ability to fill and increases the contractility of the heart to maintain homeostasis.


The cranium dysfunction mechanical changes in the gut can compress the vagus nerve at any number of locations along the vagus, slowing the heart. As the heart slows, autonomic reflexes are triggered to increase blood pressure and heart rate.

This is complemented by gastro-coronary reflexes whereby the coronary arteries constrict with "functional cardiovascular symptoms" similar to chest-pain on the left side and radiation to the left shoulder, dyspnea, sweating, up to angina pectoris-like attacks with extrasystoles, drop of blood pressure, and tachycardia (high heart rate) or sinus bradycardia (heart rate below 60 bpm). Typically, there are no changes/abnormalities related in the EKG detected. This can actually trigger a heart attack for persons with cardiac structural abnormalities i.e. coronary bridge, missing coronary, and atherosclerosis.

If the heart rate drops too low for too long, catecholamines are released to counteract any lowering of blood pressure. Catecholamines bind to alpha receptors and beta receptors, decreasing vasodilation and increasing contractility of the heart. Sustaining this state causes heart fatigue which results in fatigue and chest pain.



There is significant scope of misdiagnosis of Roemheld syndrome. Diagnosis of Roemheld syndrome 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.


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 Roemheld syndrome 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 - calcium carbonate, famotidine, omeprazole, etc. reduces acid reflux in the case of hiatal hernia or other esophageal type Roemheld syndrome.
  • Vagotomy
  • 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: Carvedilol, this will control abnormal heart rhythms, but can precipitate Prinzmetal angina and heart block.


Roemheld syndrome is characterized strictly by abdominal maladies triggering reflexes in the heart. There are a number of pathways through which cardiac reflexes can occur: hormones, mechanical, neurological and immunological.[citation needed]


Ludwig Roemheld characterized this particular syndrome shortly before his death; one of his research topics around this time was the effects of calorie intake on the heart. In Elsevier publications, there is no current research or publishing under the name Roemheld syndrome, and as a result, many cases go undiagnosed. German publishing on the subject remains untranslated as of 2009.

See also

  • Swallowing syncope


  1. Pelner, Louis (1944). The Diet Therapy of Disease: A Handbook of Practical Nutrition. Personal diet service. "ROEMHELD, L.; Treatment of Gastrocardiac Syndrome" 
  2. Hempen, Carl-Hermann; Fischer (MD.), Toni (2009-01-01). A Materia Medica for Chinese Medicine: Plants, Minerals, and Animal Products. Elsevier Health Sciences. ISBN 9780443100949. 
  3. 3.0 3.1 Saeed, Mohammad; Bhandohal, Janpreet Singh; Visco, Ferdinand; Pekler, Gerald; Mushiyev, Savi (2018-05-09). "Gastrocardiac syndrome: A forgotten entity" (in en). The American Journal of Emergency Medicine 36 (8): 1525.e5–1525.e7. doi:10.1016/j.ajem.2018.05.002. ISSN 0735-6757. PMID 29764738. 
  4. "Current Medical Literature volume 97 number 12". "p882 This complex of symptoms, for which the term "gastrocardiac syndrome" (gastric cardiopathy" 
  5. 5.0 5.1 Hofmann, Robin; Bäck, Magnus (2021). "Gastro-Cardiology: A Novel Perspective for the Gastrocardiac Syndrome". Frontiers in Cardiovascular Medicine 8: 764478. doi:10.3389/fcvm.2021.764478. ISSN 2297-055X. PMID 34869678. 
  6. "Clinical experience of treating 82 cases of gastric cardiac syndrome with traditional Chinese medicine". 
  7. 7.0 7.1 Modestus, Jamey Franciscus (October 2011). Roemheld Syndrome. Strupress. ISBN 9786137960998. 
  8. Linz, Dominik; Hohl, Mathias; Vollmar, J; Ukena, C; Mahfoud, F; Böhm, M (January 2017). "Atrial fibrillation and gastroesophageal reflux disease: the cardiogastric interaction". EP Europace 19 (1): 16–20. doi:10.1093/europace/euw092. PMID 27247004. 
  9. Ehlers, A; Mayou, RA; Sprigings, DC; Birkhead, J (1999). "Psychological and perceptual factors associated with arrhythmias and benign palpitations.". Psychosomatic Medicine 62 (5): 693–702. doi:10.1097/00006842-200009000-00014. PMID 11020100. 
  10. Lok, NS; Lau, CP (June 1996). "Prevalence of palpitations, cardiac arrhythmias and their associated risk factors in ambulant elderly.". International Journal of Cardiology 54 (3): 231–6. doi:10.1016/0167-5273(96)02601-0. PMID 8818746. 
  11. Sharma, Shekhar. "Roemheld Syndrome - Gastric Cardia". 
  12. Roman, C; Bruley des Varannes, S; Muresan, L; Picos, A; Dumitrascu, DL (28 July 2014). "Atrial fibrillation in patients with gastroesophageal reflux disease: a comprehensive review.". World Journal of Gastroenterology 20 (28): 9592–9. doi:10.3748/wjg.v20.i28.9592. PMID 25071357. 
  13. Dittler, Edgar Leon; McGavack, Thomas H. (September 1938). "Pancreatic necrosis associated with auricular fibrillation and flutter". American Heart Journal 16 (3): 354–362. doi:10.1016/S0002-8703(38)90615-5.