If you have a small hiatal hernia you've perhaps been told that your "other" symptoms, such as heart palpitations, chest tightness, shortness of breath or anxiety are not related. This can be confusing.

Educational content reviewed by licensed APRN medical staff. Not personal medical advice.
In this video Dr Vikki Petersen, DC, IFMCP explains why this confusion occurs.

Large hiatal hernias cause direct pressure on the heart and/or lungs due to their sheer size. Due to that direct pressure, the symptoms of chest pressure, heart palpitations, shortness of breath and anxiety can occur. When your doctor has told you that your small hiatal hernia cannot cause those symptoms it's because he or she is thinking with direct pressure.

What they're missing is that small hiatal hernias can cause those symptoms via a different mechanism. The pressure on the stomach causes your body's anti-reflux barriers to be overcome. The result is reflux. The reflux triggers vagal nerve reflexes leading to the symptoms I just mentioned.

These are nerve reflex responses but the symptoms are no less real.

The key is to identify the root cause of the pressure. There are a few potential causes. Some that you can address on your own are:
Not overeating
Changing your diet to include real vs ultraprocessed foods
Chew your food well
Don't lie down after you eat

Other factors you'll need some help to address:
Losing weight around your mid-section
Balance your gut microbiome - good bugs vs bad bugs
Assess any toxic load
Hormonal imbalance

References:
Hyun JJ, 2011 — Clinical Significance of Hiatal Hernia — Gut and Liver. 

Kahrilas PJ, 2008 — Approaches to the Diagnosis and Grading of Hiatal Hernia — Gastroenterology & Hepatology. 

Andrews WG, 2021 — The relationship of hiatal hernia and gastroesophageal reflux — Annals of Laparoscopic and Endoscopic Surgery. 

Cleveland Clinic, n.d. (review page current) — Hiatal Hernia: What It Is, Symptoms, Treatment & Surgery — Cleveland Clinic. 

Franzén T, 2014 — Is the severity of gastroesophageal reflux dependent on hiatus hernia size? — World J Gastroenterol. 

Wallner B, 2018 — Identifying clinically relevant sliding hiatal hernias — Scand J Gastroenterol. 

Weitzendorfer M, 2017 — Preoperative diagnosis of hiatal hernia: barium swallow X-ray, high-resolution manometry, or endoscopy? — World J Surg. 

Tolone S, 2018 — High-resolution manometry is superior to endoscopy and radiology for hiatus hernia diagnosis — World J Gastroenterol. 

Goodwin ML, 2021 — Atypical and typical manifestations of the hiatal hernia — Ann Laparosc Endosc Surg. 

Naoum C, 2011 — Left Atrial Compression and the Mechanism of Exercise Impairment in Large Hiatal Hernia — J Am Coll Cardiol. (Large HH → cardiac compression). 

Malik A, 2021 — Hiatal Hernia: A Possible Trigger for Atrial Fibrillation — Cureus (case report; association, not proof).
 
Disclaimer: The information provided in this video is intended for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your physician or other qualified health provider with any questions you may have regarding your health, medical condition, or treatment options. Never disregard professional medical advice or delay in seeking it because of something you have seen or heard in this video.
The views expressed are based on my clinical experience and current scientific understanding as of the date of publication. Individual results may vary.

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